Preparing for PGY-2 Neurology year during TY year

[Chocolateagar04]

Hi,

I am currently completing a Transitional Year program and a relatively chill place for TY although medicine months are busy. When I am on elective I have a lot of time to read and study.

I was wondering what are some suggestions some of you older residents have to best prepare me for what seems like is going to be the most challenging year of my life: PGY-2 NEUROLOGY. My future program apparently has the busiest PGY-2 neuro year in the region so I want to get a head start and make sure I get all the learning and neuroanatomy and basics of neurology down before that year.

Any books in particular that i should read? lecture series? Should I start reading journals? I haven't had basic neuroscience or anatomy since 2nd year. I really don't like reading those big huge texts but I do like study guides and interactive books like Dubins.


P.S. I know some people will say "learn your medicine itll help you for neurology" but is that really true? I feel like I should just worry learning my medicine during my floor months and ICU but not waste time during my electives studying internal medicine when I could be reading about neurology. I am asking for advice during my electives where I can read neurology related things in my free time.

Thanks!

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[bustbones26]

Hi,

I am currently completing a Transitional Year program and a relatively chill place for TY although medicine months are busy. When I am on elective I have a lot of time to read and study.

I was wondering what are some suggestions some of you older residents have to best prepare me for what seems like is going to be the most challenging year of my life: PGY-2 NEUROLOGY. My future program apparently has the busiest PGY-2 neuro year in the region so I want to get a head start and make sure I get all the learning and neuroanatomy and basics of neurology down before that year.

Any books in particular that i should read? lecture series? Should I start reading journals? I haven't had basic neuroscience or anatomy since 2nd year. I really don't like reading those big huge texts but I do like study guides and interactive books like Dubins.


P.S. I know some people will say "learn your medicine itll help you for neurology" but is that really true? I feel like I should just worry learning my medicine during my floor months and ICU but not waste time during my electives studying internal medicine when I could be reading about neurology. I am asking for advice during my electives where I can read neurology related things in my free time.

Thanks!

During my internship, I really did focus on learning general medicine simply because I wanted to pass my step III. I did not want to start off my PGY-2 year having to explain to my PD why I failed step III or had not yet applied for a license, so I really did make it my focal point. I took my step III by December and passed, so I did spend those last few months getting ready for neurology.

My advice:

Neuroanatomy through clinical cases by Blumenfeld.
Learn the exam!!! Most program make doing proficient exams a key component of the PGY-2 year.

Buy a copy of Laughing your way to passing the neurology boards, by Amy McGregor. Boy I wish somebody shared this tip with me back in the day!!! I went into my RITE exam without ANY knowledge of pediatrics (heavily tested) or neuropathology and it hurt!!! Reading this particular book will at least have you somewhat prepared for your first RITE. My program had heavy emphasis on the RITE. If you did poorly on the RITE (and I did my first year), then they treated you very different, trust me on this!!! Also, DEMAND that somebody cough up the old RITE manuals for review. Again, I did not do this until it was too late.

Yes, your PGY-1 rotations will be very important depending on your institution. Since most academic neuro programs have their own admitting service, some choose to essentially be their own internist, so having a solid background in managing common ward medical problems will help you out in your senior PGY years.

 

[95439]

If you have an elective month, it's a great time to do neuro research if that's a possibility. Fellowships love applicants with research and it'll help you down the road. Otherwise I mainly agree with BustBones. This is the one year of your life you'll really focus on IM, and it is relevant. I always looked at medications people were taking to see if they had any neurologic side effects that you may come across in the future. Study for Step 3 and get it out of the way, but it will be easier if you do it later in the year when you've absorbed most of the information already. If you have to do case presentations, try to do Neuro case presentations, they'll help you learn the topic, and then you can re-present them next year when you'll likely have to do more of the same ;o)

 

[BlackFrancis33]

A lot of this depends on you. How much studying will you need to do to pass step III? That is different for all of us. If you can spend extra time studying neurology that will do nothing but help you as a PGY2, and prepare you for that first RITE exam. I would not spend all your time studying/learning internal medicine as a PGY1. You will learn what overlaps with IM as a neurology resident. bblues recommendation to correlate what you can to neurology is a good approach when you can. I would also recommend learing the neuroanatomy. I am also a Blumenfeld fan. If you already know your neuroanatomy and the neuro exam pretty well, I would start looking at Localization in Neurology (Brazis). I wish I would have started that earlier. Stick with 1 strategy (e.g. getting through a book) as all of us have our favorite neurology references.

 

[Mattchiavelli]

some pointers
-let all your teams know you're going into neurology and they will usually let you have dibs on patients being comanaged with neurology as long as it doesn't upset the order of the team too much. That way you get to follow along somewhat by reading the neurology notes and following the neuro exam, seeing what are good ways to interact with medicine services and what aren't, that kind of thing
-since you're in a TY try to do an elective in something neurology-adjacent, something like neurosurgery, neurorehab through PM&R, pain clinic, or geriatrics

for books, I have a plug- all the PGY-2s got a copy of Emergency Neurology edited by Roos, she's in our department (there's my conflict of interest) but it's been well received and I personally like it. Make yourself familiar with emergencies, how to quickly spot them and what to do with them initially. When you're on your first call it's very helpful to know when you need to be moving quickly and in what direction and when you can take a history, do your physical, peruse the EMR, really think about what's going on before you staff the patient. If you don't use that one specifically use another book based on emergency neurology issues, those will be the scariest and most intense issues you will be dealig with as a PGY2, if someone pimps you on neuropath you can always look it up and come back with an answer.

 

[Chocolateagar04]

Hey,

Thanks for the replies.

Yeah I'm on ER right now and I try to hog all of the remotely Neuro cases I can. Same with when I was on the floors last month. Thanks for all the advice. I just bought the blumenfield book and it seems so in depth but easy to read.

Also, I'm a pretty audio/visual typle learner. Are there any video series for neurology that people use?

Thanks for the advice.

 

[danielmd06]

Some points:

1) Focusing on internal medicine is a great idea, at least until you have the basics of IM down. If you want to pick up extra knowledge in a particular area, I would recommend cardiology, and critical care. Both were quite helpful to me later on in neurology. But don't go overboard. For instance, advanced gastrointestinal or renal issues and such never had a high yield for me.

2) Wholeheartedly agree with advice to learn a true neurologic exam and anatomy. You can burnish knowledge with neuroimaging studies on your patients, and rotations in neuroradiology, ophthalmology, and neurosurgery and books such as Blumenfelds (mentioned above), and the Duane Haines Atlas of Neuroanatomy. Radiology and ophthalmology also make for nice off-service rotations where you can cool your heels after brutal IM floor months, too. If you're up for it, I cannot emphasize enough how much stronger I became for doing three months of neurosurgery in medical school. Just be prepared to work if you choose that route. I was always a fan of the Greenberg Handbook of Neurosurgery.

3) Learning "emergency neurology" is a fantastic suggestion, and one not often mentioned on these boards to my recollection. May I also suggest a pretty decent book meant for EM and IM residents and near perfect for PGY-1 neurologists-to-be titled Principles and Practice of Emergency Neurology by Shah and Kelly.

4) Doing neurology rotations may be helpful also, and I don't want to dissuade you from doing this, but I personally felt that once I picked up as a PGY-2, I was smothered in neurology floor work and never seemed to have enough time for the electives such as PM&R. So I would argue to make those types of months a priority if your own program is similarly heavy as compared to my own.

5) Since you specifically asked, you can find good video material online through here: http://www.cmeinfo.com/store_temp/Comprehensive_Review_of_Neurology__506.asp

But be forewarned...these DVD's are solid teaching tools, but prohibitively expensive.

6) Old RITE exams are the best way to prepare for new RITE exams. Trust me on that one.

Best of luck as you start off on your nascent career!