Program Overview

Rush Inpatient Care

In 1997, Rush opened a technologically advanced 20-bed inpatient unit that includes monitoring systems for patients leaving the intensive care units as well as video-EEG monitoring rooms for epilepsy patients. The unit houses all patients with primary neurological diagnoses including stroke, neuromuscular diseases, epilepsy, multiple sclerosis and movement disorders. There are four inpatient services at Rush University Medical Center: Stroke, Neurocritical Care, General Neurology and Epilepsy/Multiple Sclerosis.

Stroke Service

While on the stroke service, residents are expected to gain proficiency and exposure to pharmacotherapeutics commonly employed for stroke prevention as well as acute therapeutics such as intravenous tissue plasminogen activator, heparin, intra-arterial options including thrombolytics and mechanical embolectomy. In addition, they are expected to learn the National Institutes of Health Stroke Scale and become proficient at basic vascular anatomy and review CT, MRI, and conventional angiographic imaging on a daily basis.

The stroke service consists of one senior neurology resident (PGY 3 or 4), one junior neurology resident, one or two rotating residents, a stroke PA, and a stroke attending. It acts as the primary service for stroke patients on the neurology ward and provides stroke consults for other inpatient services. Typical admissions include intracerebral hemorrhages, strokes, and TIAs, from both the Rush ER and outside institution transfers. Both the Stroke and neurocritical care services round jointly on cerebrovascular patients in the neurosciences intensive care unit daily.

Neurocritical Care Service

Under the direction of Dr. Temes, the Neurocritical care service provides residents exposure to novel treatments for acute neurologic injury, including intracranial pressure monitoring, hypothermia, and invasive hemodynamic monitoring. Residents attend daily multi-disciplinary teaching rounds alongside nurses, pharmacists, nutritionists, and physical therapists.

The neurocritical care service is responsible for providing both primary and consultative care to patients admitted to the Neurosciences Intensive Care Unit (NSICU). The neurocritical care team consists of a neurointensivist and neurocritical care fellow, one senior neurology resident, one junior neurology resident, one anesthesiology resident and one medicine critical care/pulmonary fellow. Typical admissions to the NSICU may include subarachnoid hemorrhage, intracranial hemorrhage, malignant ischemic stroke, status epilepticus, mysasthenic crisis or Guillain-Barre syndrome, among other acute neurologic conditions. Residents may also perform, assist, or observe interventional procedures. When patients are discharged from the NSICU, patients will be triaged to the appropriate team for continued care.

General Neurology Service

The general neurology service consists of one neurology senior resident (PGY 3 or 4), one junior neurology resident, one or two rotating residents, up to five medical students and a neurology attending. The team acts as a primary service for general neurology patients on the neurology floor, and also provides neurologic consultations for patients admitted to other inpatient services. Attending rounds with the general neurology service occur daily.

Epilepsy/Multiple Sclerosis service

The Epilepsy/Multiple Sclerosis service consists of one neurology senior resident (PGY 3 or 4), one junior neurology resident, a nurse practitioner and both an epilepsy and multiple sclerosis attending. It is the primary service for patients followed by the Epilepsy and Multiple Sclerosis Sections who are admitted to the neurology floor. Like the other neurology services, the team is responsible for all of its own admissions and other patient care duties. Unlike the other services, this team does not cover hospital consults, only inpatients and infrequent ER consults on epilepsy or MS section patients.

On-Call Responsibilities at Rush

Neurology call at Rush is covered by one PGY2 neurology resident and one PGY3/4 senior neurology resident. During the first year of training, junior neurology residents split four 2-week night float rotations. The responsibilities of the junior resident include cross-covering the primary patients on all neurology services (except Neuro-ICU), admitting primary patients to all neurology services, and seeing new consults in the hospital and the emergency department. The junior resident is called first for any non-emergent neurology consultation after 4PM.

Call is evenly split among the senior neurology residents during their third and fourth year. For urgent situations, the senior resident must be at the patient’s bedside within 30 minutes at any time. Emergency department consults and acute stroke pages are first directed to the senior resident. Each day, one of the senior residents is the “senior- of-the-day” and triages all pages to during a 24-hour period.

Call for the Neurocritical care service is covered by residents rotating on the neurosciences intensive care unit. Q4 call is split between a junior neurology resident, senior neurology resident, anesthesia resident, neurocritical care fellow and a moonlighter. The responsibilities of the NSICU resident include cross-coverage, admissions and seeing new consults in the neurosciences intensive care unit. Admissions to the NSICU may include direct admissions from home, transfers from other hospitals and emergency room admissions.

Rush Outpatient Care

Resident Continuity Clinic

Each resident is assigned to work in a continuity clinic for a half day each week. The clinic follows a private-practice model. Patients are referred from regional physicians and Rush physicians, and appointments are scheduled and confirmed by the clinic's staff. Full-time, academic general neurologists supervise the clinic.

Subspecialty Outpatient Rotations

During the PGY-2 year, each resident completes a dedicated 2-week outpatient rotation in the Rush Movement Disorders Center and another 2-week rotation through various subspecialty clinics, including multiple sclerosis, HIV, dementia, neuro-ophthalmology, neuromuscular, stroke and epilepsy. During the PGY-3 and PGY-4 years, at least four months of subspecialty outpatient rotations are completed, chosen from among all of the subspecialties of neurology.

Conferences

The Department of Neurological Sciences offers a variety of conferences. Weekly conferences include Neurology Grand Rounds, Clinical Neuroradiology Conference, Chairman's Rounds with the Residents, Neurology Residents' Ambulatory Neurology Conference and the Neurology Residents' Basic Science Didactic Course. Monthly conferences include Journal Club, Neuropathology Conference and Pediatric Neurology Conference. In addition, there are a number of weekly subspecialty-based conferences, such as Movement Disorders Video Rounds, Clinical Neurophysiology Conference, Seizure Surgery Conference and Neurovascular Conference. There is also a weekly Neuropathology brain-cutting session.

Neurology at Stroger Hospital of Cook County

Stroger Hospital is a public health care facility adjacent to Rush. Through an academic affiliation between Rush and Stroger Hospital, Rush residents have the opportunity to see patients at both institutions. Stroger Hospital serves a diverse population, affording residents opportunities to treat a wide range of neurological problems. Weekly case conferences, lectures and neuropathology conferences add to the academic experience.

Residents have several rotations at Stroger Hospital of Cook County throughout the 3 year program. The traditional academic hospital environment allows the resident to assume responsibility for the care of patients under the guidance of the attending staff. In this setting, clinical skills in history and physical examination are emphasized in the daily care of patients who have neurological diseases. A team of one senior and one junior neurology resident, senior medicine residents and medical students, handle inpatient consults and staff the busy outpatient clinics. The number of consults and admissions evaluated by the team totals about 100 each month.

While rotating at Stroger Hospital, residents participate in 2-3 half day neurology clinics per week. Neurology attendings from Stroger Hospital and Rush staff the patients seen by residents. The neurology clinics take place in the state-of-the-art ambulatory space of the new hospital.