Residency Program Policies and Procedures


Augusta University Neurology Residency Program

Neurology Residency Program Links:

APPLICATION PROCESS AND REQUIREMENTS

GOALS AND OBJECTIVES

POLICIES AND PROCEDURES

GENERAL INFO

I. Appointment and Selection 

II. Promotion 

III. Dismissal and Grievance

IV. Evaluation, Supervision and Duty Hours

V. Moonlighting

 I. Appointment and Selection

The Neurology Program will select residents after screening applications, inviting most qualified candidates for interviews, and evaluation by faculty and current residents. A rank order list will be prepared by the Program Director after consultation with the faculty and chief resident.

 III. Promotion

A resident will be promoted when, in the opinion of the faculty, the resident has performed acceptably and demonstrated mastery of the knowledge and skills at the current level and has no non-academic performance matters which warrant attention by the Program Director.

 

 III. Dismissal and Grievance

Dismissal

The Program Director has broad latitude to act for the good of the program, in the interest of patients and as a resident advocate.

The Program Director and other faculty as needed may counsel a resident who fails to perform satisfactorily. A period of probation and performance goals may be established by the Program Director and approved by the faculty. A resident who fails to meet the established goals during the period of probation may be dismissed. This information will be communicated with the resident and documented in their file.

A resident may be dismissed when the Program Director finds academic deficiencies or non-academic performance difficulties that cast grave doubts upon the resident’s potential capacities as a neurologist.

A resident will be afforded appropriate due process when the circumstances warrant it.

Grievance

The Neurology chief resident, faculty advisor, and residency director are available to advise/assist the house officer with any grievance they may have. The Department follows institutional policies, which require multilevel hearings, due process, timely notice and accurate records if disciplinary action is required.   Residents appeal any disciplinary decision through the Residency Director.  When the appeal is before the departmental RRC, the house officer may choose to speak directly to the committee and/or have their chief resident, faculty advisor, or residency director present their appeal.  The response will be promptly discussed with the resident.

After a departmental decision has been made, the House Officer may appeal decisions to Dean of the School of Medicine within 10 working days after being notified of the Chairperson's final decision and the reason the House Officer is asking that the decision be reversed or modified.

The House Officer may or may not remain on duty during the appeals procedure depending on the nature of the issue involved and the departmental RRC’s decision.  The Department, upon becoming aware that an appeal is being made, will advise Hospital Administration, through the appropriate Assistant Hospital Director, of such appeal. 

IV. Evaluation, Supervision and Duty Hours

Faculty evaluation

Each spring every resident completes an evaluation of the residency program. Program area evaluations are reviewed at the following faculty meeting. The chairman reviews faculty evaluations individually with faculty members.         

Resident Evaluation

Each resident is evaluated by the responsible "on service" faculty member at the end of each rotation. The resident is asked to review evaluation and record his/her comments.  The Residency Director reviews these results individually with the resident at least every 3 months or immediately, if either the faculty member or resident notes any problems. Monthly assessments are filed in each resident's evaluation folder and may be reviewed by the resident at any time.

The Departmental Residency Review Committee (RRC) consists of the Clinical Faculty.  This committee meets monthly to review the course of the training program, resident performance records, and mediates problems as they are identified. 

Residents choose faculty advisors during their first year and they meet throughout their residency. Faculty help residents chose electives, organize and supervise research or other scholarly activities, and advise them on professional concerns such as choosing career paths.

When resident performance warrants further intervention, a formal conference between the resident, her/his advisor and/or the program director is held. If serious problems are present, a status of "probation" is established after the situation is reviewed by the departmental RRC. The resident is informed of this action and a written copy of specific goals to be achieved by the resident are reviewed with him/her, signed, and filed. Probationary status is permitted only for a limited time; outlined goals must be met within the agreed upon time period, to have this status removed.

Supervision and Duty Hours

General Notes

The Augusta University Neurology residency will adhere to ACGME guidelines concerning attending physician supervision of residents and resident duty hours. This includes adhering to the maximum of an 80-hour average workweek and the 24-hour in-house call provisions by the ACGME. There will be a minimum of 10 hours between work periods. Senior residents (PGY-3 and PGY-4) do not have in-house call and therefore will not fall under the 24 hour on call statute. Senior residents who moonlight outside their MCG residency duties must adhere to the 80-hour maximum average workweek (see Section V.)

Monday through Friday each workday will officially start with Morning Report at 7:30am.

Residents are given a total of 3 weeks or 21 working days of vacation each year. In general, vacation and time off for professional meetings should be taken during subspecialty rotations and electives. Time off during a general rotation is discouraged but if time off is required during a general rotation (neurology ward, neurology consults, or neurology practice site), it is the responsibility of the resident to obtain approval from the chief resident, then supervising attending, then residency director. This must be done 2 months in advance for vacations and at least 30 days in advance for other absences. No more than 7 days of vacation may be taken out of the Pediatric Neurology rotation during the 3 years. Notification to the clinics, ward service, consult service, paging operator, etc. is the responsibility of the resident. 

Night Call Responsibilities

(5:00pm - 7:00 am) and weekends are covered by a junior resident (1st Call) and a senior resident (2nd Call). Coverage includes wards, consults, and EDs for both Augusta University and the VAMC. The 1st call resident is expected to remain in house. There is a designated neurology call room on the 9th floor of Augusta University. Meal money is provided to the 1st call residents if they stay in house for call. The money is transferred at the end of each month.

Calls from the neurology ward go first to the junior resident. If there is any question, the senior resident, and if necessary, the attending should be called.

Calls from the Epilepsy Service go to the junior resident on call. These include patients in the unit as well as post op patients. If there is any question, the Epilepsy Attending should be called. Patients in the Epilepsy Monitoring Unit are there for monitoring of their seizures. If further problems arise the attending should be called.  

Calls from the Augusta University ED and from other Augusta University services (consults) go to the junior resident. The 1st call resident should evaluate the patient and call the 2nd call resident to review the case. If there is any question, the attending should be called. If the consulting service asks for the neurology attending, the attending should be called.

Calls from outside ED’s and from referring physicians should go to the neurology attending. The attending may call the junior resident or senior resident to see the patient or deal with the situation, but the attending is responsible and should be kept informed.

The first call resident is expected to present all patients seen in consult or in the Augusta University ED or VA-Life Support Unit to the second call resident. The first call resident is urged to check out any ward service problems with the second call resident if he/she feels uncomfortable with the situation.       

First call residents are not authorized to defer ED patients to the neurology clinics. Appropriate clinic referral is the responsibility of the second call resident, who is also responsible for notifying the clinic nurse and practice site attending of the patient’s scheduled appointment as soon as possible.      

It is essential that the on call resident contact the ward team and the consult service early the next morning, on weekends as well as weekdays, for any admissions or medical follow up.

Residents are responsible for handling calls between 8:00 am- 5:00 pm from their continuity clinic patients.


MCG at Augusta University and VA Ward Resident

Basic Responsibilities

The neurology ward resident is responsible for the care of all patients on the neurology ward. The ward resident can assign an appropriate number of patients to be followed by a resident from another service, but the neurology resident should have detailed knowledge of every patient’s medical condition. The visiting resident should not be primarily responsible for more than 2 ward patients.

The neurology ward resident should perform a primary admission neurological examination on all patients on the ward service. If the initial history and physical examination were done by another resident while on call, the neurology ward resident should perform a neurological exam on the patient the next day and document it in the chart.

The ward resident is responsible for making sure that the plan of action for all ward patients is carried out. This includes writing orders, following up laboratory data, writing consultation requests, and reviewing radiographic studies. Some of these duties can be delegated to a visiting resident or a student, but these must be closely supervised by the neurology ward resident.   

The neurology ward resident is responsible for daily progress notes on all patients on the neurology ward. The neurology resident should write the progress notes on his/her patients and should ensure that any visiting residents write daily progress notes on their assigned patients. The student’s notes should be reviewed and cosigned by either the ward resident or the visiting resident who is following that patient. However, student notes do not substitute for the notes written by a physician.

Discharge summaries and letters to referring physicians are to be dictated by the ward resident in a timely fashion. Outpatient follow-up should be in the resident’s continuity clinic or with the appropriate attending, whichever is deemed appropriate by the ward attending. A copy of the discharge summary should be sent to the referring physician. 

Discussion of a patient’s case with family members or referring physicians may be done by either the ward resident, the visiting resident, or the attending, but it is the resident’s responsibility with the attending physician to ensure that the family and the referring physicians are kept updated. 

The ward resident should obtain the assistance of the consult resident, chief resident, or the ward attending in the event of an emergency with any patient.

The ward resident and visiting resident will handle all calls concerning the inpatients on their service between 8:00 am - 5:00 pm.

The ward resident is responsible for checking out patients to the first call (and when indicated, 2nd call) resident.

The VA resident must attend the VA neurology clinic on Tuesday and Wednesday mornings.

Attending work and teaching rounds should be daily Monday - Sunday by the neurology ward and consult services with the assigned teams. Rounds should be held between 8:00 am and 6:00 pm unless there are extenuating circumstances. The consult resident is not required to round with the ward attending, but he/she should have frequent communication with the ward attending. 

Both the Augusta University and VAMC neurology residents are required to attend their resident continuity clinics. The VAMC resident will attend VA general neurology clinics.

MCG at Augusta University and VAMC Consult Resident

Basic Responsibilities

The neurology consult resident is responsible for the care of all inpatient consults seen by the neurology service. The consult team is responsible for seeing consults from 8:00 am - 5:00 pm Monday - Friday.  Consults must be seen the same day they are called in.  The consult resident should check out inpatients consults with the on-call service when appropriate. All inpatient consults will be seen and examined by the neurology consult resident and presented to the consult attending in a timely fashion.

The neurology consult resident is responsible for seeing all neurology consultations in the ED before a disposition is made. These patients should be presented to the consult attending either verbally, or the attending should see the patient personally. If a patient is to be admitted either the consult or ward attending will also evaluate the patient. The consult resident should notify the ward resident of admissions. If the consult resident admits a patient, he/she will write admission orders and the admission H & P.

Between 8:00 am and 5:00 pm, calls from outside EDs and physicians should be directed to the consult attending, when requested.    

The neurology consult resident must communicate effectively with the referring service, ensuring that our recommendations are known by the referring service. The consult resident should follow-up on any studies that we recommend.

The neurology consult resident should arrange for neurology outpatient follow-up for consult patients when it is necessary.

The neurology consult resident may assist the attending in handling phone referrals and transfers from outside physicians and hospitals and directing them appropriately.

The neurology consult resident is also responsible for supervision of the visiting residents and students who are on the consult service.

Consult rounds are to be arranged between the consult resident and the attending and should be finished by 6:00 pm. 

EEG/Epilepsy Resident

Under the direction of the attending physician, the Epilepsy/EEG resident is responsible for the care of all patients on the in-patient Epilepsy Service. The Epilepsy/EEG resident is also responsible for seizure management of post-operative patients following epilepsy surgery.

Under the direction of the attending physician, the Epilepsy/EEG resident attends the epilepsy clinics each week. The Epilepsy/EEG resident is responsible for reading the EEGs in the EEG/EP Lab on a daily basis. The resident should review the EEGs prior to the reading session with the attending. The attending reading session is held each morning immediately after Epilepsy Service rounds.

Each of the Epilepsy/EEG attendings will provide a series of teaching sessions to cover epilepsy and EEG during the rotation. This may include a review of textbooks, review of articles, or other assignments.

EMG/Neuromuscular

Under the direction of the attending physician the EMG/Neuromuscular resident will be responsible for the initial evaluation of patients referred to the EMG laboratory for testing. This will include proper documentation and generation of the results of all testing. EMG (needle examinations) will be done under the direct supervision of the attending physician. The EMG/Neuromuscular resident will also follow patients admitted to the inpatient neurology service with primary neuromuscular problems and assist the ward resident with daily evaluation and management. The EMG resident will attend the weekly Muscular Dystrophy Association Clinic. 

Pediatric Neurology

Under the direction of the attending physician the Pediatric Neurology resident will be responsible for the care of patients admitted to the pediatric neurology service, consultation requests to pediatric neurology and will attend all pediatric neurology outpatient clinics. The pediatric neurology resident will also return patient phone calls as directed by the pediatric neurology attending. 

V. Moonlighting

Moonlighting outside the Neurology residency is allowed during the PGY-3 and PGY-4 years. Moonlighting must be approved by the residency program director and by the department chairmen. Moonlighting must not interfere with residency responsibilities and moonlighting hours must comply with policies concerning residency duty hours.