Residency & Fellowship Programs
Why Wayne State University's Neurology Residency?
The shortest answer is “options.” As people go through their residencies, their plans often change. Someone initially expecting to join a private practice may end up with a career in academic medicine. To keep all their options open, residents need exposure to the widest possible variety of patients, neurological problems, and clinical settings. Residents need to understand the neuroscience that explains the diseases they treat and the treatments they provide. Perhaps most of all, they need experienced and supportive faculty to see them through.
Over the past few years, Wayne State University School of Medicine and the Detroit Medical center (with which the medical School is affiliated) have undergone tremendous growth. We are one of Detroit's largest non-governmental employers and one of the largest medical centers in the nation. When we say that our residents see a variety of patients here, we mean that they see rich and poor patients; patients from the medical center's backyard and patients from around the world; primary, secondary, and tertiary care patients. Residents have the opportunity to follow up on patients over the long-term, in a continuity clinic, and to work in our broad range of subspecialty and interdisciplinary clinics.
The medical school and center's expansion has enabled the Department of Neurology to grow as well. We added fifteen percent of our faculty in 1994. Our 35 full-time faculty members engage in clinical or basic research; some do both. Of course, numbers alone do not tell the story. The faculty biographies located on the neurology website show how many different institutions our faculty has had contact with. The varied backgrounds and research interests of the faculty help our residents in several ways. First, the aggregate amount of neurology they can teach surpasses any single person's ability to absorb it. Most of our faculty members have more than one clinical interest or subspecialty. Second, they have contacts all over the country, which they build or renew as they attend academic conferences, give talks, or collaborate with colleagues. When our residents complete our program, they can call upon this vast network for help in their post-residency plans and placement.
Our Departmental Philosophy
Our faculty views our residents as colleagues. We want our residents to perform as independently as is consistent with good patient care. The more expertise and initiative residents bring to their work, the less significance anyone attaches to distinctions between “attending” and “resident.”
Some departments may see teaching, patient care, and research as discrete parts of their mission. We dedicate our department to providing unexcelled patient care because we assume that research and teaching are an integral part of that mission. Physicians, after all, do research in a quest for better solutions to their patients' problems. Teaching, which requires the faculty to articulate and re-evaluate the scientific premises of their treatment behavior, also enhances patient care.
What Do Wayne State's Neurology Residents Do?
Like most fully accredited neurology residencies, our program has its structure determined, in large part, by the accrediting board. We have five to seven residents in each year. Generally, five specialize in adult neurology, and two specialize in pediatric neurology.
The three main components of residency training comprise inpatient rotations in a variety of hospital settings, outpatient work in our general neurology, specialty, and interdisciplinary clinics, and the study of neuroscience.
Junior residents divide their time between Harper University Hospital, Detroit Receiving Hospital (DRH), and the Veteran's Administration Hospital (VAH). In addition to these inpatient responsibilities, all residents spend two half-days a week in outpatient clinics. They follow their own patients (under faculty supervision) in the residents' general neurology and continuity clinics.
Senior residents spend six to eight months supervising junior residents, medical students, and internal medicine, neurosurgery, and psychiatry rotators at Harper, DRH, and VAH. Each resident spends 3 months at Children's Hospital. In addition to following their own patients in residents' general neurology and continuity clinics, senior residents also have a rotation in the University Health Center's specialty clinics, which include the multiple sclerosis (MS), stroke, epilepsy, neuro-oncology, neuromuscular, neuro-ophthalmology, pain, and movement disorder clinics.
The electives offered to senior residents include: neuropathology,
neuroradiology, electroencephalography and evoked potentials, sleep, electromyography, physical medicine and rehabilitation, neurosurgery, psychiatry, neuro-ophthalmology, neuro-oncology, neuromuscular disease, and stroke. If residents wish, they may also use elective time to work on research projects.
The three aspects of a resident's training, inpatient care, outpatient care, and neuroscience education are discussed in greater depth in the sections that follow.
Inpatient Learning Opportunities
Inpatient Care
For historical reasons, most teaching hospitals are located in larger cities. With the national trend towards suburbanization, some may see this as obsolete, but big cities supply a large enough population for a resident to see all but the rarest of diseases at least once. Living in the nation's sixth largest metropolitan area, the potential patient population in Detroit alone comprises a broad range of ethnic and socioeconomic groups. The Detroit Medical Center hospitals, however, attract patients throughout Michigan, the rest of the Great Lakes region, and the world.
All residency work is performed at the hospitals that comprise the Detroit Medical Center (DMC). DMC has a 110-acre complex in downtown Detroit that consists of six hospitals (including Veteran's Administration Hospital), plus Wayne State University School of Medicine facilities. These include our extensive medical library and basic research center. Unlike some Residency programs, which require on-call residents to see all the neurological patients admitted to an entire center, our program allows residents to concentrate on the patients within a particular hospital. All of the hospitals provide neurological consultations, and DRH, Harper Hospital, Children's Hospital, and the VAH have neurology units.
At those four hospitals, each junior resident works with one other junior under the supervision of a senior resident and a faculty attending physician. The resident on-call handles all admissions to the neurology service and all consultations. Each patient a resident admits becomes the responsibility of the admitting resident.
The hospitals at which our residents work are described below.
Harper University Hospital (HUH)
With 650 beds, Harper is DMC's largest teaching hospital. It provides primary through tertiary care and enjoys an international reputation for the neurosciences. Full-time faculty admits the majority of Harper's neurology patients, although some private physicians also have admitting privileges. Neurology faculty research has enabled Harper to develop leading clinical programs in neuroimmunology, neuro-oncology, neuromuscular diseases, epilepsy, stroke, and neurodegenerative diseases.
Harper houses the DMC's Magnetic Resonance Imaging (MRI) Center, which in addition to performing routine imaging, also can perform MR spectroscopy, MRA, fMRI and angiography. Harper also has a three-bed epilepsy monitoring unit and an eight-bed stroke unit.
Junior residents spend about four months at HUH; senior residents, a little under three months. On average, the neurology service admits about 400 to 500 patients per year and performs 1600 consults.
Senior residents may choose to do the following electives at Harper: neuropathology, neuroradiology, neuro-oncology, epilepsy, neuromuscular disease or stroke.
Detroit Receiving Hospital (DRH)
With 340 beds, DRH specializes in adult emergency and trauma care. It houses a specialized unit for traumatic brain injury.
As at Harper, the residents work in teams of two juniors, a senior, and a faculty attending. Faculty do not admit their own patients to DRH; instead, patients arrive at the emergency room and, when consulted, neurologists determine whether to admit patients to the neurology floor or to another service. Admissions to the neurology service average 400 to 500 patients a year. Each year, the neurology staff also performs approximately 1600 consultations that result in a patient either being admitted to a non-neurological service or being discharged without admission.
Junior residents spend about four months at DRH; senior residents, a little under three months.
Junior residents also spend 1-2 months on the neuro-ICU service. The department also offers fellowships in neuro-critical care and stroke.
The types of neurological disorders DRH residents most commonly see include cerebrovascular disease, seizures, traumatic injury of the nervous system, and infectious, toxic, and metabolic encephalopathies.
Veteran's Administration Hospital (VAH)
Most of WSU School of Medicine departments maintain services at the VAH. Neurology maintains its own 20-bed inpatient unit. A new VAH opened in the DMC's mid-town campus a few years ago.
The residents at the VAH work in one-junior/one-senior teams. Admissions to the neurology unit have averaged 100 to 200 per year; the annual number of consultations averages 500. Residents assigned to the VAH also staff its outpatient clinic. Senior residents may do their sleep elective at the VAH, and the department also offers a sleep fellowship. The most common diseases found at the VAH are cerebral vascular diseases, degenerative diseases, and seizure disorders.
Children's Hospital of Michigan (CHM)
CHM is a 260-bed hospital run by the Wayne State University Department of Pediatrics. CHM has a Positron Emission Tomography (PET) scanner unit. Its director is the Chief of the Division of Child Neurology. Pediatric neurology functions as a distinct division with CHM. That division's attendings hold Wayne State faculty appointments in both Pediatrics and Neurology.
All senior residents spend a least three months at CHM, handling both inpatient and outpatient duties. The pediatric neurology service has an average of 400 admissions annually and performs approximately 750 consults. Residents see all types of neurological complaints, including those unique to children.
Hutzel Hospital and Kresge Eye Institute
Hutzel houses the medical center's Department of Obstetrics and Gynecology. The ophthalmology department runs the Kresge Eye Institute. Neurology residents provide consultations to those departments. Residents may also do electives in neuro-ophthalmology.
Rehabilitation Institute of Michigan (RIM)
The Rehabilitation Institute is the Midwest's largest specialty hospital and treatment center for adult physical medicine and rehabilitation. Its specialties include many related to neurological problems: traumatic brain injury, spinal cord injury, multiple sclerosis, and stroke. Neurology provides consultant services, and our residents may take a physical medicine and rehabilitation rotation as an elective.
Outpatient Learning Opportunities
Outpatient Care
Every resident spends one half-day in clinic per week seeing new patients under the supervision of faculty. Every other week, residents spend one half-day seeing their own patients in the general neurology continuity clinic. These patients often come from the communities surrounding DMC and have been referred by primary physicians. The kinds of neurological complaints seen at these clinics commonly include headache, seizures, degerative diseases, but also include some less common disorders such as syringomyelia, neurosarcoid, autoimmune diseases, and some neuromuscular diseases.
The second half-day is devoted to each resident's ongoing patients in the continuity clinic. These are patients the resident has previously seen sometime during his or her residency. The resident may have cared for these patients on an inpatient basis when they were admitted to the neurology service or when another service required a neurological consult. Once a resident has seen a patient for the first time in the general neurology clinic, the resident sees that patient for any subsequent visits in the continuity clinic. The continuity clinic provides residents with a hands-on experience in two of the key aspects of being a practicing physician: forging long-term, ongoing relationships with patients and managing chronic diseases.
In addition to these clinics, each resident spends 2 months in the specialty clinics. Most of the clinics are located in the University Health Center. The multiple sclerosis, neuromuscular, epilepsy, movement disorder, and neuro-ophthalmology clinics are multidisciplinary.
Some faculty are involved in other specialties' multidisciplinary clinics. For instance, the infectious diseases division runs an AIDS clinic, and neurology faculty consults on neuro-AIDS problems. Interested residents can arrange to participate in these clinics as part of their electives.
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