curriculum

NM1

C. Miller Fisher was active in teaching and resident
interaction even in his later years. This photograph
was taken by the residents during in invitation to his
home. Dr. Fisher is the namesake of the MGH
Vascular Neurology Service (the CMF service).

[This section is described by the current residents, for our future residents. It has been edited only for clarity, not content. We encourage you to discuss this section with the current neurology residents if you have any questions.]

The NM1, or junior, year is the most clinically intensive of the training program. We are most definitely a front loaded program, and you can expect to be immersed in neurology during this year. But invariably, residents finish this year more confident and with a good set of basic principles. This year is mainly inpatient (ward and ICU service), with an average of slightly less than Q4 call. There are also several months of Emergency Department consultations – which are call free but very demanding and hectic (there are well over 100,000 ED visits between our two main hospitals, and neurology is one of the most commonly consulted services). Besides 4 weeks of vacation, there are only 2 weeks that are call free, overnight shift free, and weekend free (a ½ block of EEG reading). In some cases, another 4 weeks of outpatient rotations could be call free, but often you will help cross cover a ward service with Q4 overnight call. Additionally, you will spend one month rotating on the neurosurgery service, learning more about trauma management and neurosurgical principles.

In the NM1 year, the bulk (about ¾) of the cases will be vascular neurology and other neurological emergencies (e.g., AIDP, neuro-oncological cases, complicated demyelinating disease, and status). A large minority of cases will be unusual presentations not seen outside of an academic quaternary care facility. The cases seen on our ward and ICU services are used for the CPC cases in the New England Journal of Medicine. “Bread and butter” neurology cases (uncomplicated neurodegenerative diseases, demyelinating diseases, brain tumors, and seizure disorders) are also seen. You will also see a fair number of “bread and butter” cases through a weekly outpatient continuity clinic (which continues for all three years).

Sample Schedule for NM1 (PGY-2) Year

7/1 -
7/14

7/15 -
7/28

7/29 -
8/11

8/12 -
8/25

8/26 -
9/8

9/9 -
9/22

9/23 -
10/6

10/7 -
10/20

10/21 -
11/3

11/4 -
11/17

11/18 -
12/1

12/2 -
12/15

12/16 -
12/29

Vacation

12/30 -
1/12

1/13 -
1/26

1/27 -
2/9

2/10 -
2/23

2/24 -
3/9

3/10 -
3/23

3/24 -
4/6

4/7 -
4/20

4/21 -
5/4

5/5 -
5/18

5/19 -
6/1

6/2 -
6/15

6/16 -
6/30

Vacation

Our view of the workload: This is a call heavy, and at times, tough year. 70-80 hours per week is typical. In addition, the volume of cases is high (MGH has 2200 inpatient neurology admissions/year; BWH with 1300 neurology admissions/year), but the majority of cases provide incredible learning opportunities [link to a neuropath case]). That said, there is constant supervision and we really feel that this year was well worth the effort. When you graduate from being an NM1 it is amazing how well trained you already feel, especially in handling complex neurological emergencies. And while it is tough, you are never alone. There is always a senior resident in house with you (not to mention other junior residents) and all decisions and procedures are under close supervision (by the seniors and faculty). The faculty (most of whom trained within the Harvard system) are always supportive and always available.

Modern and historic collide in the MGH Etherdome during Neurology grand rounds. The amphitheater was once
a surgical operating theater, and is the site of one of the first uses of ether as an anesthetic during an observed
surgery. Today it houses a variety of museum quality historic medical equipment, an actual sarcophagus and
mummy (seen beside the screen and behind the podium), as well as an array of audio-video computer equipment.

our program