How important is the PGY1 year for neuro residency?

[neuronwangyu]

a little bit depressed...
currently as an intern in the hospital without teaching and full of scutwork
trying to learn as much as possible but still afraid that the poor quality of my pgy1 training will affect my future neuro training.

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[typhoonegator]

Depends on the neuro residency, to some degree, as some are more ward service heavy than others. You won't be doing many paracenteses, if that's what you were worried about...

I'm sure you're picking stuff up along the way. As long as you're seeing lots of patients, you'll learn.

 

[Neurologee]

Agree with above - yes, it would be great to have formal teaching, but if the only thing you do is see a ton of patients and look up any questions you have about evidence based medicine as it applies to treating those patients, you will learn a lot more than you realize ...

 

[doxtyp]

Same question was bothering me. Internal medicine is so vast. Are there any particular things/disciplines/procedures that I should learn well that would be particularly important for neurology residency?

 

[typhoonegator]

Well, if you have a neuroICU in your program, then thoracenteses, subclavian, IJ, and femoral lines will be helpful skills to have under your belt. Obviously you'll need to become good at LPs, but that mostly happens in your junior year anyway.

Neuro ward patients can be pretty sick, and the catecholamine surge leads to some funky heart issues at times. Make sure you are getting proficient training in arrhythmias like Afib with RVR and SVT, because you'll be dealing with them fairly frequently. Aspiration, impending airway emergency, and pulmonary edema are other common issues.

There will always be internal medicine people who are there to help, so try not to worry too much about it, but the more you feel comfortable handling yourself, the more confident you'll be as a neuro junior. That confidence will allow you to spend more time learning the neurology, because you'll be less consumed by these ancillary medical issues.

Remember, not all programs are the same. Some have smaller ward services (or none) and some neuro services tend not to assume primary responsibility for patients with a lot of medical issues. So take my recommendations with a grain of salt.

 

[neurologist]

Sorry to hear about all the scutwork

Agree with Typhoonegator that the cardiac stuff comes up a lot, so get as good a handle as you can on that.

In many hospitals, internal med or ER teams do lots of the LPs, so any chance you get, volunteer for those. If any of your patients gets any kind of neuro imaging, look at it.

To try to keep yourself sane (and learn a little neuro along the way), take a couple of minutes for each patient you see and try to figure out (or read about) "how could their current medical problem manifest in a neurological way?" Like for a pneumonia, read about pneumococcal meningitis or hypoxemia. Or stroke in an afib patient. Or hepatic encephalopathy in a hepatic failure patient, or HIV dementia in an AIDS patient, peripheral neuropathy in a cancer chemo patient, etc. It's helpful, because next year you'll be getting called to do neuro consults for all that stuff, so starting to think about it now will make you more familiar with it over the next couple years

 

[neuronwangyu]

Thanks. What you suggested is absolutely right. The book "the interface of neurology and internal medicine" teaches me a lot.

Sorry to hear about all the scutwork

Agree with Typhoonegator that the cardiac stuff comes up a lot, so get as good a handle as you can on that.

In many hospitals, internal med or ER teams do lots of the LPs, so any chance you get, volunteer for those. If any of your patients gets any kind of neuro imaging, look at it.

To try to keep yourself sane (and learn a little neuro along the way), take a couple of minutes for each patient you see and try to figure out (or read about) "how could their current medical problem manifest in a neurological way?" Like for a pneumonia, read about pneumococcal meningitis or hypoxemia. Or stroke in an afib patient. Or hepatic encephalopathy in a hepatic failure patient, or HIV dementia in an AIDS patient, peripheral neuropathy in a cancer chemo patient, etc. It's helpful, because next year you'll be getting called to do neuro consults for all that stuff, so starting to think about it now will make you more familiar with it over the next couple years

 

[undecided3yr]

I agree with the others. Having observed other residents in my program who went to a cush pseudoacademic internship as compared to those who were academic, it made a huge difference.

Whenever you have your own ward and stroke service it matters and again as above it really matters if you have a NeuroICU at your program.

 

[pazu]

Whenever you have your own ward and stroke service it matters and again as above it really matters if you have a NeuroICU at your program.

Hmm, I know of several strong programs (Rochester, Maryland, UNC, Pitt, Michigan) that do not have their own closed Neuro ICU, but they still see ICU patients...of course, this means they serve more as consultants and are not the primary care team. I don't think the residents at these programs are struggling as a result of not having their own Neuro ICU, although if you planned to do neurocritical care, then you might want to do an elective elsewhere.