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Teaching:.
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Schedule
The PGY-2 year is busy, but not as busy as other programs. Things have improved tremendously since Dr Preston became the PD. There is a Q 4-5 call for PGY-1 with inhouse back up for the first 3 months in the University Hospitals & 2 months for the VA. For PGY-3 yr the call schedule is Q 5-6/month & for PGY-4 it is Q 3-4/months. There are 4 teams- general neurology & stroke (with a senior resident {PGY4}, assistant senior {PGY3} and 2 neuro residents in each, the general neurology team may have additional medicine, psych, ophtho & FP rotators. The PGY-4's job is to manage the team & the PGY3's job is to get the nightfloat {PGY2} out on time to keep the ACGME hours. PGY3's also play an educational role getting articles, studies & papers for the rotators & medical students.), NeuroICU & Epilepsy. NICU has 2 PGY2s supervised by the NICU fellows where one gets ICU experience including central lines & arterial lines. Epilepsy service is run by a PGY3/4 with the epilepsy fellows, PGY2s do not play a role in it.
Teaching
There is a 1.5 month Neuroanatomy course, 2 month EEG course with Dr Hans Luders, 2 months EMG course with Drs Katirji & Preston. There is excellent exposure to stroke in the PGY-2 year with Tony Furlan & Cathy Sila mentoring the PGY-2s. There is daily Neuroradiology teaching in morning rounds & thrice a week witht the neuroradiology chief. There is a weekly stroke conference, weekly neuroradiology conference, weekly Journal Club, weekly grand rounds & monthly neuroophthalmology conference. There is a weekly Epilepsy conference where attendance is optional. PGY-3 year is largely educational & PGY-4 year is largely administrative, running the teams-general/consult, stroke, NSU, or epilepsy. There is 2 months exposure in the NSU in the PGY-2 & 3 years.
Residents run the Journal Club, PGY3s have to do a clincal neuropathological conference each month-1 for each that year & PGY4s do the morbidity & mortality conference for their services (about 4 each-2 general neurology & 2 stroke service).
Atmosphere
There is good cameraderie amongst the residents. Most of the faculty is congenial & approachable. They are great to work with. There is a very good exposure to neuroophthalmology at the VA with Dr John Leigh & neurorehab. At neurosurgery postings you will see cortical mapping & DBS implants besides the regular stuff. The Movement Disorders experience is in clinics along with headache. Cleveland is cheap to live in. There is the lake to swim in in summer & a lot of places to eat. There is no parking problem a la NY. Fellowships are worldclass here in Epilepsy (Hans Luders), Stroke (Tony Furlan/Cathy Sila), Neuro critical Care (Michael DeGeorgia), Neurophthal (John Leigh) & Neuromuscular (Preston/Shapiro/Katirji). Cleveland is bad in winter. Snows can go upto 2 feet. But the lifestyle is good after PGY-2 year & the teaching is so good that it makes everything else tolerable. There is no better program in the US if you are looking to get a great general neurology training before going into your fellowship.
Research
Depends on the enthusiasm of the residents. Most get case reports in the major journals by their PGY-4 year. Some work with the faculty & get clinical research papers out. Basic science research can be done if one is pushy & is willing to put in extra time.
Fellowships
There are fellowships in the following:
NICU: 2. Relatively good compared to most places. But honestly, if I wanted to do it, I would head for Mayo/Columbia/JHMI/Medical College of Wisconsin/UCLA/Wash Univ/U Chicago.
Vascular Neurology/Stroke: 1. Great training. Well rounded fellowship with acute stroke, neurointerventional, neuroradiology, neurosonology, rehab, outpatient & NICU.
INR/ESNR/Interventional Neurology: Call it what you like. Case is finishing with training its first neurology fellow in it. There was a lot of resistance from the junior INR faculty to this & he was badmouthed a bit in his first few months. But he has almost made it. Let us see if there will be any more neurologists trained here (looking at the way things are, this seems to be the future of this branch). The case load is moderate-650 per year which is not impressive when compared to some of the neurology/neurosurgery run programs. Research output is pathetic as is aggression since the INR faculty is mostly radiologists with little understanding of the pathophysiology of stroke. Surprizingly, no stroke decisions are made on APECTS scores & CT perfusions are not standard.
EEG/Epilepsy: 5+2-3(research). One of the world's leading places in for an epilepsy fellowship with a second year available for cortical mapping & intraoperative training. A fair amount of epilepsy surgery with the only center in the US (& 2nd in the world) with sub-pial punch resections for temporal lobe epilepsy.
EMG: Good EMG fellowship with NM pathology component. However there is no NM medicine/M&N biopsy exposure if that is what you want to do. Better places to go to are U Rochester, Wash Univ, Emory & Mayo. I would place Case at no. 5 in the country. But one of the best if you wanted to learn just EMG-Preston, Katirji & Shapiro are here. Diaphragmatic pacing being studied here for ALS. Autonomics training under Chelimsky is some neurology & some voodoo.
Neuro-ophthalmology: 1. Again one of the leading places in the world for this specialty. John Leigh, Robert Daroff & Dell'Osso have a large well funded lab at the VA. Dr Tomsak (Ophthalmology) is responsible for the clinical side of things. There is a robust research program.
Movement Disorders: They are trying to find funding for starting a fellowship. May have one in the next few years. There is a good DBS surgery program & David Riley runs a botox clinic. The infrastructure for a fellowship is there but funding is a problem.
Extras
The faculty has written numerous books & quite a few are made available for free. The year I was there I got the following:
NICP, EMG by Preston/Katirji, EEG by Levine & Luders, Wolf's headache, a $1500 book fund which got me- JP Morh's Stroke, Plum & Posner, Queen's Square book on Peripheral Nerve injuries, Diagnostic Neuroangiography-Osborne & Mayo Clinic Board review book, books from winning the monthly neuroradiology quiz-Neuropathology, Neuroimaging Brain-Osborne & Expert DDx-Osborne.
As a PGY4 I had a poster at the AAN which I got to go to for free- poster cost, airticket, hotel & car rental paid for by the department.
Resident futures
In the last 4 years all residents have made it to fellowships at:
EMG/NM: Case, Emory, U Rochester
EEG/Epilepsy: Case
Vascular/Stroke: UPMC-Pitt, Case
INR/ESNR: Duke, U Louisville
Neurocritical care: U Chicago, CCF, Case
Neuroonc: U Texas-M D Anderson, Houston; Sloan-Kettering, NY
Sleep: CCF, Stanford, Wayne State.
Conclusion
One of the best programs in the US which is underrated because it is in Cleveland Ohio. Certainly much better than a lot of other programs I interviewed at for my fellowship. Great faculty & great teaching.
