Overview by year
PGY-1 (preliminary internal medicine)
Our neurology residency is a four-year categorical program which allows you to integrate into our system early so that you can focus on learning neurology. Our first-year internal medicine training at Barnes-Jewish Hospital is exceptional and provides residents with a solid foundation in clinical practice. Interns rotate through the medical intensive care unit (MICU) and inpatient floors, including the cardiology specialty service and other specialty services. Interns spend time on internal medicine electives as well as the hospitalist procedures team. The internal medicine department prides itself on being “resident run,” and with the complexity of the patients seen at Barnes-Jewish, you will become proficient in the management of the most common illnesses that prompt admission to the medicine service.
We are unique in that the psychiatry requirement is fulfilled as an intern, freeing more elective time during your neurology training. As an intern on the psychiatry service, you will lead an inpatient service with the guidance of an attending physician and gain experience in acute primary psychiatry.
Uniquely, our interns are also well-integrated into the neurology department and spend several weeks on our inpatient neurology services which include the consult, primary neuro-hospitalist general neurology and primary vascular neurology services.
In order to provide early EEG exposure and prepare for the PGY-2 through 4 years, our interns also spend time taking care of patients and learning how to read EEG on our epilepsy monitoring unit service. In order to give our interns early exposure to neurology subspecialties to help with fellowship and career planning, you will also rotate through dedicated blocks of subspecialty attending clinics including neuroimmunology, neuroinfectious diseases, movement disorders, neuro-oncology, epilepsy, sleep medicine, neuromuscular medicine, neuro-ophthalmology, and cognitive neurology. Those pursuing our physician-scientist track may take elective time for research as early as the intern year.
This is the first year of formal neurology training and is the most demanding year but will provide immense exposure to every type of neurological illness. Residents spend the majority of the year rotating on the inpatient general neurology and stroke services with a team of neurology, pediatric neurology, psychiatry and PM&R residents. Our PGY-2 residents also spend time as junior residents on the consult service as well as on the hyperacute stroke service.
Unique to our program, the PGY-2 on the consult and hyperacute stroke services sees all code strokes, does the NIH Stroke Scale and makes the decision to give thrombolytics and/or mechanical thrombectomy after discussing the case with a stroke attending and/or the PGY-4 chief resident. Our program has led efforts to allow for more resident autonomy in acute stroke decision making. There is one month dedicated to the neurology/neurosurgery intensive care unit where residents will take primary responsibility for critically ill patients with neurologic conditions. All of our inpatient rotations utilize a night float system. By the end of this year, residents are confident and function independently on the inpatient services, including making decisions on the acute management of hemorrhagic and ischemic stroke. Our PGY-2 residents gain further exposure with dedicated blocks for subspecialty clinics, EMG and EEG.
The goal of this year is to transition into the role of a senior resident. For 8-10 weeks, you run the neurology consult service with faculty supervision, which sees patients on other services and in the Emergency Department. You also serve as the mentor for the other members of the team which includes a neurology PGY-2 or pediatric neurology PGY-3, internal medicine residents, psychiatry interns and PM&R interns. You will help transition junior residents into the role of making acute stroke management decision, including administering TNK. This year will push you to gain the skills needed to be an effective team leader in the healthcare system. The remainder of the year is spent on night float, inpatient neurology, neuro ICU, and elective time.
Residents can use their elective time on one of many of our clinical elective rotations, medical education teaching rotations, or perform clinical/basic science research. Custom elective rotations can also be built anywhere within our institution. Those on our master clinician track will work with their mentors to develop an appropriate curriculum. Residents will have the opportunity to rotate with our community neurology partners in a “Community Neurology Practice” rotation. Lastly, six weeks of inpatient pediatrics at St. Louis Children’s Hospital is incorporated into the PGY-3 year.
This year includes 10 weeks serving as either the inpatient stroke or general neurology service chief resident. This rotation is the capstone experience for our residents where they serve as pre-attending on our busy inpatient neurology rotations. The chief is given the opportunity to lead all aspects of the service including accepting admissions, guiding the junior residents with management decisions, assisting with acute stroke management decisions, and most importantly, overseeing a busy and complex inpatient service. With faculty supervision and guidance, they lead an academic inpatient neurology service and mentor junior residents and interns from numerous programs, nurse practitioners, sub-interns, and medical students. They learn to incorporate excellent evidence-based clinical care with education and strong team leadership.
Our graduates are universally ready to enter into both academic and community practice upon graduation due to this enriching experience. The remainder of the year is divided into elective and rotations through adult and pediatric subspecialty clinics, allowing for ample time to master your clinical knowledge, round out your residency experience, continue to conduct your scientific research and write grants, and gain experiences to promote achieving your career goals, whatever they are.
“If you can think of it, there’s a WashU resident who’s done it.”Omar Butt, MD, PhD ’20
The program takes pride in providing the most elective time of any adult neurology residency program in the country — 35 weeks for exploring clinical or research interests.
Medical student education
Multiple sclerosis clinic
Neuroradiology catheter angiography