WRAMC IP Neurology
(Updated April 24, 2007)
PGY year in which clinical experience occurs, whether required or elective, and duration of training:
Required for one month during PGY1 (or in PGY-2 if not completed during PGY-1)
Description of faculty staffing, including discipline and full-time/part-time status: The WRAMC
Neurology inpatient service is staffed with by full time staff neurologist, a senior neurology resident (usually a
PGY4), and two PGY2 neurology residents from the NCC Neurology Residency Training Program. The
WRAMC Neurology Department has 10 Neurologists on staff. The inpatient team has available sub
specialists in epilepsy, movement disorders, neuromuscular disorders, neurophysiology, headache, neuro-
behavior, neuro-ophthalmology, and traumatic brain injury. The neurology inpatient service has 24 hour
access to electroencephalography (EEG), evoked potential, electromyography (EMG) and nerve conduction
studies, CT and MRI neuro-imaging (including MRA, DWI and MRS-specialized neuro-imaging techniques).
Description of educational methods: The PGY-1 psychiatry resident is an integral part of a team
consisting of a senior neurology resident, a junior neurology residents, and medical students, all under the
supervision of the staff neurologist. The PGY-1 psychiatry resident is directly involved in the day to day care
of hospitalized neurological patients. The PGY-1 psychiatry resident performs admission histories and
physical examination which are either directly observed or supervised by a senior resident or staff member.
Cases are discussed at the time of admission with regard to differential diagnosis and treatment approach.
The team meets with the attending for one to two hours per day, including weekends, to discuss and
examine new patients and to discuss management of patients previously admitted.
In addition to patient management, the resident is required to attend the many scheduled learning
opportunities available to all residents. (See Clinical Rotation Schedule attached). Wednesday mornings are
devoted to didactics. The morning is filled with five, one hour sessions consisting of: a neuro-imaging
conference, neuro-pediatric conference, neuroanatomy or neurophysiology lectures, grand rounds, and the
clinical lecture series. The neuro-imaging conference is led by neuroradiologists who present images and
lead discussions on cases provided by the neurology physicians. The neuroanatomy/neurophysiology
lecture series is led by a neurology resident who reviews in depth an assigned topic and shares this with the
group. Grand round lectures are given by invited guests who are experts in their fields giving current and
relevant information on a variety of neurological topics. The clinical lectures series include presentations on
subjects such as epilepsy evaluation and treatment, brain injury management and outcome, stroke
treatment, neuromuscular disease, neuro-genetics, and ethics. Chiefs Rounds are conducted by the chief of
the department where a live patient is examined in front of the residents and the discussed.
Breadth of clinical population and experience, including socioeconomic status, sex, age,
ethnic/cultural mix, diagnosis and type of treatment: Patient age ranges are from 18 years to 95.
Disorders include multiple sclerosis, headache, stroke, peripheral neuropathy, myasthenia gravis, dementia
disorders, neurodegenerative disorders, movement disorders, traumatic brain injury and epilepsy. Ethnicity
approximates that of the general population of the United States and gender is nearly equal for men and
women. Many of the patients are active duty military. Patient receive comprehensive evaluation including
neuro-imaging (MRI, PET, and, SPECT),carotid angiography, carotid ultrasonography, echocardiography,
EEGs, evoked potentials, nerve conduction studies, sleep studies, and long term video-EEG monitoring for
seizure disorders, and neuropsychological testing. Treatments include use of anticonvulsants, anti-migraine
medications, anti-thrombotic agents, immune modulating therapy, and other complex medication regimens.
Consultation to a wide range of specialties is readily available. Examples of services include: dermatology,
ophthalmology, orthopedics, neurosurgery, vascular surgery, physical medicine and rehabilitation as well as
physical, occupational, and speech therapy. Unique to Walter Reed as a military institution is a
comprehensive Traumatic Brain Injury service as well as an Amputee service.
Average and maximum case loads and description: Each inpatient team manages between 5 and 10
patients on average, with an average length of stay of 5 days. The average new admission rate per team is
one per day.
Scheduled supervision: frequency and whether individual or group: Residents receive one hour or
more of supervision for each new admission and 2 hours per day of group supervision per day during
Other (including any other important information relevant to clinical or educational experience): The
WRAMC neurology service is a world wide referral center for complex neurology cases. Residents on this
service see both common and extremely complex neurological cases. Residents are encouraged to
observe and participate in studies ordered for their patients done by the neurology service including nerve
conduction studies, neurobehavioral assessments, review of EEGs and video-EEGs.
PGY-1 Psychiatry Residents have ½ day per week of intern clinic