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 a heavily consulted service). However, there are outpatient experiences as well in this hectic year, including: a dedicated epilepsy rotation and a VA clinic/subspecialty clinic block. In addition, there are 4 additional weeks of outpatient clinic rotations, usually with overnight cross-coverage on one of the ward services (Q4 overnight call). Additionally, you will also spend 2-4 weeks on the neurosurgery service, honing 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: A challenging year, but one which provides an excellent clinical basis for the role of senior resident. The year provides a balance between independent decision making and supervised guidance by the senior residents and attendings. There is close interaction with seniors as well as junior and senior faculty in clinic and on the wards. The emergency department in particular allows juniors to be the first neurologists to see complex and interesting cases (yet still with close senior residents and attending supervision). 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 (many of whom are alumni of this program) 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 artifacts (including an actual sarcophagus and mummy),
in addition to an array of audio-video computer equipment.

our program