Clinical Rotations

Curriculum

Our clinical rotations are divided into inpatient and outpatient rotations. During the inpatient months, we spend most of our time at the high volume, tertiary referral center, Memorial Hermann Hospital in the TMC. Here we run inpatient services for stroke, general neurology, Neuro-Trauma ICU, and the Epilepsy Monitoring Unit. In addition to these, residents manage a busy consult service and spend time on the pediatric neurology consult service in the Children’s Memorial Hermann Hospital. Additional rotations are spent in the Harris County system. Most notably, residents run a high-volume consult service at Lyndon B. Johnson General Hospital, which has one of the busiest emergency rooms in Texas.

Stroke

During this rotation emphasis is on the following:

  • Acute stroke management
  • Stroke evaluation to determine etiology
  • Application of the latest evidence on stroke care

Being one of the busiest stroke centers in the country, residents gain hands-on experience taking care of patients with ischemic stroke, hemorrhagic stroke, and complex cerebrovascular disorders. Residents also become comfortable with administering tPA, post-tPA care, and managing patients of all ages from young adults to the elderly.

General Neurology Inpatient

Patients are admitted to the service from the UT Neurology clinics, through the ER, as transfers from surrounding hospitals or come from other countries for evaluation. Pathologies range from status epilepticus, myasthenic crisis, Guillain-Barre, Multiple Sclerosis exacerbations, autoimmune encephalitis, and more.

During this rotation, there will be a PGY4  who is the “super” in a pre-attending role which prepares the residents for independent practice. The PGY-2 resident on service will have a “senior” role under the supervision of the PGY-4. The residents manage these patients under the direction of a neurohospitalist attending.

General Neurology Consults (at MHH-TMC)

Residents are exposed to the wide array of neurological conditions seen at a tertiary care, level I trauma center. Consults range from infectious meningoencephalitis to seizure management to prognosis of recovery after anoxic brain injuries.

Neurocritical Care

Residents have the opportunity to work in the state of the art 32-bed NeuroICU caring for patients with severe strokes, status epilepticus, post-operative neurosurgical patients, and other neurology patients requiring intensive care due to their condition. Residents learn about the management of patients with high acuity conditions including elevated intracranial pressure, subarachnoid hemorrhages and vasospasm, and spinal trauma.

Epilepsy Monitoring Unit

Patients are admitted for a 3-5 day stay in the unit for continuous monitoring. Emphasis is placed on reviewing EEG recordings with the attending, adjustment of antiepileptic medications during the stay and eventually planning for epilepsy care after discharge.

The resident participates in the once weekly Epilepsy Case Conference. This conference is attended by epileptologists, epilepsy neurosurgeons, neuroradiologists and behavioral psychologists. Patients are presented and surgical options discussed with the entire team.

Residents also have the opportunity to go into the OR during the epilepsy surgery to witness intraoperative monitoring, Wada tests, and other relevant procedures.

LBJ Consults

Residents are exposed to a wide variety of neurological diseases in various stages of progression while on the LBJ consultation service. This rotation is in PGY3 and PGY4 years, and the resident has the opportunity to truly act in the capacity of an independent consultant while training our internal medicine colleagues in neurologic diseases.

Pediatric Neurology

Residents work with the pediatric neurology fellows in managing both the outpatient clinics and inpatient consult services. Residents are exposed to a wide array of pediatric neurology conditions from epilepsy to mitochondrial disorders to developmental disorders like autism.

Psychiatry

PGY4s spend 1 month with the psychiatry consult liaison service at MHH-TMC. They will get exposed to various psychiatric illnesses, many of which overlap with common neurologic disease processes.

Smith Clinic

The Smith Clinic is part of the Harris County Health system which serves the underserved population, and our residents attend outpatient continuity clinics here during PGY1-PGY4 years. Our PGY1 residents will participate in weekly continuity clinics while on neurology rotations and medicine consult rotations (totaling about 7 months). This is a unique opportunity for PGY-1s to start care early and continue that care throughout their residency. In addition to continuity clinics, there are multiple subspecialty clinics that residents will rotate through during their residency. These clinics include MS, Movement, Neuromuscular, Epilepsy, and Procedure clinics.

Ambulatory (includes subspecialty clinics- see below)

This rotation gives residents the opportunity to experience the different neurological subspecialties. Residents work one-on-one with the attendings in caring for the wide array of patients that come from Houston, other parts of Texas, the Gulf region, or even other parts of the country and the world.

Epilepsy/EEG Course

At UT Houston we have a unique opportunity to learn fellow-level EEG reading skills during our PGY-2 or PGY-4 years. This is an 8-week course dedicated to learning about EEGs, seizure semiology, seizure treatments, surgical epilepsy treatment, and all things epilepsy. We encourage all residents to participate in this course prior to graduation. If you are interested in epilepsy it is recommended you take the course your PGY-2 year (you do this during your 4 weeks elective and 4 weeks EMU). If you are not doing epilepsy we encourage you to take this course during your PGY-4 year so you have a strong foundation prior to graduation. This course includes residents, epilepsy/neurophysiology fellows, as well as practicing neurologists from the community. Definitely a great opportunity to take advantage of during your time here!

Electives

Various months are available for electives (depending on the year of training), for a resident to explore more of the subspecialties in depth. Many residents also use their electives as dedicated research time.

Subspecialties/Electives

  • General/Diagnostic neurology
  • Epilepsy
  • Multiple Sclerosis
  • Neuromuscular (including nerve conduction studies/EMG)
  • Movement disorders
  • Vascular neurology
  • Neuro-oncology at MHH or MD Anderson
  • Sleep Medicine
  • Pediatric neurology
  • Neuropathology
  • Neuroradiology
  • Dementia
  • Neuro-ophthalmology
  • Interventional neurology
  • Neurocritical care
  • Neurorehabilitation
  • Headache
  • Mobile Stroke Unit
  • Pain Medicine
  • Tele-neurology
  • Neurohospitalist