The general neurology inpatient service at University Hospital, commonly referred to as "the Red team," is the heart of the inpatient experience during your residency training. Comprised of an attending, one senior neurology resident, 2-3 junior neurology residents, and several UAB medical students, the red team takes care all neurology inpatients except stroke and seizure monitoring unit patients. There is a different attending every month of the year and, without exception, each attending is eager and willing to teach.
We admit patients to this service with such problems as complicated seizures, neurological diseases requiring procedures/infusions (such as IVIg or Plasma Exchange), tertiary referral diagnostic conundrums, and a host of other neurologic complaints. As with all inpatient services at UAB, there is exceptional support from ancillary medical professionals (nurses, pharmacy, PT/OT, speech, dietary, social workers) so that residents have ample time for patient care and reading time. Junior neurology residents are allowed autonomy to diagnose and treat their patients with guidance and back-up close by from the senior neurology resident and an always-available attending.
The Stroke Service takes care of all patients with a suspected diagnosis of stroke, vasculitis, dissection or other vascular problem involving the CNS. The team is comprised of an attending, senior resident, junior resident, rotator (usually neurosurgery), physician assistant and medical students. We have a dedicated Stroke Unit of Sparks 8th floor (S8) and a dedicated Neuro-ICU where we have ample support from Critical Care teams to help assist with ventilatory management and severe medical complications. Our physician assistant on the service helps us arrange disposition and covers very stable patients that are awaiting placement or rehabilitation.
We have a hospital-wide “Code Stroke” system that is activated in the event of acute neurologic deficits that are suspicious for stroke. This ensures that radiology is ready and waiting for the patient’s STAT head CT, the attending and fellow are made aware, an ultrasonographer is notified, and the home call resident is notified. We have a very active Code Stroke program and administer tPA, on average, 3 times per week. This number has been consistently climbing over the past few years and our residents are very comfortable and confident in making decisions whether or not to give tPA to stroke patients.
All of our residents complete 1-2 months of SMU coverage. Much of your time during this rotation is spent on the inpatient epilepsy service, also known as the Penfield Epilepsy service, which includes a seven bed video EEG monitoring unit. Most of the admissions to this service are scheduled ahead of time, so you usually know who is coming in for monitoring and when they will arrive. The most common reasons for admission are:
- Classification of seizure type. Epileptic or non-epileptic? Partial versus generalized?
- Significant medication changes
- Pre-surgical evaluation. Some epilepsy patients may be candidates for surgical treatment. We do the pre-surgical "work-up" here, which may include any combination of the following tests: MRI with 3.0T scanner, MEG scanning, PET or SPECT scanning, epidural/subdural electrode recording, neuropsychological evaluation, and WADA testing.
If a patient is a good surgical candidate, our neurosurgery colleagues do a resection. Over 500 resection surgeries have been performed in the last several years for epilepsy patients.
Each morning you will review excerpts from the 24-hr EEG/video recordings with the fellow and attending to look for ictal and inter-ictal abnormalities. After rounds, the resident is responsible for doing H&Ps and discharge summaries. In the afternoon, the resident interprets the routine EEGs done that day (from everywhere in the UAB system, including outpatient and inpatient) with an attending and a fellow. After two months of epilepsy, you will have reviewed about 100-150 routine EEGs and over 250 24-hour video EEGs.
The VA neurology service covers both neurology inpatients and neurology consults at the Birmingham VA Medical Center. The inpatient service includes a bed devoted to 24-hour EEG monitoring for epilepsy patients. The service is staffed by a VA neurology attending, a senior neurology resident, a PGY-2 neurology resident, possibly one or two rotating residents (often psychiatry residents), and a few medical students.
The upper level neurology resident performs EMGs two half-days per week. Besides attending a continuity clinic at the VA, residents also attend a VA staff attending subspecialty clinic five half-days per week. Because of this extra clinic, you will not have your Cooper Green continuity clinic during the VA rotation.
Because the VA Hospital is located just across the street from University Hospital, residents can easily and quickly walk across the street to attend the lectures and conferences. The VA service is a very realistic neurology experience because you will take care of inpatients, perform consults, read EEGs, perform EMGs, and go to clinics all in the same rotation!
The consult team sees all inpatient neurological consults at University Hospital and Cooper Green Hospital. The team consists of an attending, a senior neurology resident, a junior neurology resident, and one to three rotating residents. The rotating residents are residents in other specialties (internal medicine, psychiatry, neurosurgery) who are doing a neurology rotation. The consult team sees anywhere from two to eight consults a day. This structure of the Consult Service allows time for each Resident to adequately review the latest research and guidelines on each question posed.
Neurology residents have one month on the consult service during the PGY-1 year, 2 months during the PGY-3 year, and 2 months during the PGY-4 year. This allows for a gradual increase in clinical decision-making responsibility during your four years of training. Each graduating UAB Neurology Resident is well equipped to handle any and all Neurological questions.
On consults, you can expect to see many different neurological aspects of medical and surgical diseases. Because UAB is a leader in so many different medical and surgical specialties and subspecialties, your experience on the consult service is unique and challenging. For example, many transplants (heart, lung, liver, pancreas, and bone marrow) are performed at UAB, which inevitably leads to some uncommon and challenging neurological problems.
The consult experience at University Hospital is complemented by the experience at Cooper Green Hospital. Being a county hospital serving the indigent population, these patients have very different neurological issues than the population at University Hospital. It is important to be familiar with neurology as it presents from all walks of life. Combining these various settings for consultation will ensure that you will be very comfortable with neurological consults of any kind.