Welcome to the Downstate Neurology Residency Program at One Brooklyn Health! We are delighted to have you join our Brookdale Neurology family. Our program’s mission is to serve the needs of the local community of Central and Northeast Brooklyn. Brooklyn is NYC’s melting pot, comprised of a racially, ethnically and socioeconomically diverse population. The immediate Brooklyn community served by OBH is socioeconomically challenged and has a marked need for increased accessibility to neurological care. Residents in our program are trained to practice neurology with an awareness of health inequities and the social factors that contribute to health. They are taught to optimize available resources to provide cost-effective healthcare.
The aims of the Downstate Neurology Program at OBH are as follows:
(1) to train residents to become clinically competent and culturally competent independently functioning neurologists.
(2) to graduate a pipeline of general neurologists to provide community healthcare in Brooklyn and to serve as master educators for the next generation of medical students and residents.
(3) to instill habits of professionalism and lifelong learning.
(4) to provide the highest quality of care to every patient.
(5) to encourage intellectual curiosity and a scholarly approach to patient care, utilizing careful analysis of symptoms and signs and localization to determine the appropriate next step in patient management.
(6) to emphasize the importance of teamwork and to incorporate and value all members of the healthcare team in the daily care of patients.
(7) to provide patient care and training with a continuous focus on health inequities, cost containment, and social determinants of health to best serve our diverse patient populations.
SPONSOR: Our program is sponsored by SUNY Downstate Health Sciences University; Downstate GME oversees all aspects of our program, and all neurology attendings affiliated with this program have Downstate faculty appointments. OBH provide salaries for the residents, faculty, and support staff of the program.
HOSPITAL SITES: Our residents see patients exclusively at the One Brooklyn Health (OBH) system. Inpatient rotations are entirely at OBH-Brookdale Hospital, located at 1 Brookdale Plaza, Brooklyn, NY 11212. Weekly continuity clinics are also at this location. Other specialty clinics are located at OBH-Kingsbrook Jewish Medical Center, located at 585 Schenectady Avenue, Brooklyn, NY 11203. No more than 1 month per year will be spent at Kingsbrook site.
All faculty that participate in educating the Downstate-at-OBH residents hold Downstate faculty appointments. This includes not only physicians who work in the inpatient and outpatient settings at OBH, but also those who provide didactic sessions and conferences. Downstate’s Neurology Grand Rounds & noon conferences are available to the OBH program over Zoom.
Daily morning report is more than just a sign-out session; it is a key educational experience for all residents on service and is attended by all members of the inpatient team along with the night float resident. The manner in which morning report is conducted ensures that the night float experience is an educational one. Similarly, attending rounds on all services are scholarly in approach. Noon conference takes place daily and covers key topics, starting with an introductory series over the summer for the new residents, followed by thematically grouped sessions across the year. Additional regularly scheduled conferences each month include neurosurgery/neuro-oncology, neuroradiology, neurobehavioral, neurorehabilitation, quality improvement, morbidity and mortality, basic science review, board review, case presentation, and journal club.
Every year of training has incremental competency-based learning objectives, which are distributed at the start of each year. Every rotation has its own learning objectives as well. Residents are expected to achieve milestones in each of the competencies appropriate to their level of training. Attendings submit written evaluations on resident performance at the completion of each rotation, and continuity clinic attendings complete evaluations every 3 months. Additional evaluations are solicited from nursing, staff, patients, students, and peers (360˚ evaluations). All evaluations are reviewed by the Clinical Competency Committee (CCC) and the Program Director. The CCC completes a milestone evaluation on each resident every six months to ensure each resident is making satisfactory progress, and the Program Director discusses their findings with each resident. Each resident also takes the Neurology RITE examination (Resident In-Training Examination), which provides feedback to the resident on his or her knowledge as compared to others nationwide at the same level of training. Our residents are expected to score no lower than 50th percentile on the RITE examination. A professional learning plan will be developed by the CCC and the Program Director together with each resident every six months to aid in the resident’s achievement of competence in each of the six competencies. It is hoped that with proper attention to our feedback and guidance, each resident should attain the skills necessary to practice neurology independently upon completion of our three-year residency training program.
The year is divided into 13 four-week blocks (52 weeks per year). Each year, each resident gets one block (two half-blocks) of vacation time. The remainder of the year is distributed as described below for each year of training.
5.5 blocks ward (each session 1.0-1.5 blocks long to mitigate burnout)
1.0 block psychiatry
1.5 blocks night float (done as three half-blocks)
1.0 block OPD (done as two half-blocks)
3.0 blocks elective time (neuroradiology, clinical neurophysiology, interventional stroke, PM&R, neurocritical care, headache, pain management, neurosurgery, clinical research)
3.0 blocks consult
2.0 blocks pediatric neurology
1.5 blocks night float (done as three half-blocks)
1.0 block OPD (done as two half-blocks)
4.5 blocks elective (pain management, EMG, neurocritical care, clinical research, et al.)
2.5-3.0 blocks ward senior
2.5-3.0 blocks consult senior
1.0 block pediatric neurology
1.0 block OPD
4.5-5.0 blocks elective (1 month allowed off-site with exemption from continuity clinic)
One half-day per week is spent in continuity clinic across all 3 years. Residents may not miss clinic for more than four consecutive weeks. Residents are excused from continuity clinic only when on vacation or on night float.
Our program utilizes a night float system. Night float services are provided by the R1 and R2 residents (1st and 2nd year of neurology training). The night float resident works 6 nights per week for two weeks at a time, covering neurology consultations for a 12-hour overnight shift each night for 6 consecutive nights. The one night per week that is not covered by the night float resident will be covered on a rotating basis by R1 and R2 residents who are not on night float (no more than once a month per resident, on average).
Daytime coverage on weekends and holidays will be provided by the residents who are on service only; this will minimize errors in transitions of care. Residents on the inpatient teams work a 6-day week, covering a 12-hour day shift on either Saturday or Sunday each week. This allows residents who are not on service to have their weekends free.
On weekdays, residents covering inpatient services take turns providing short-call coverage (4:30-7:30 PM) to allow the rest of the inpatient team to leave at a reasonable time each day Monday through Friday, with just one designated resident staying each evening late enough to sign off to the night float resident.
Senior residents (R3’s) provide on call coverage from home, serving in a supervisory capacity, fielding questions and providing support to the in-house on call residents. The two senior residents on service will split the weekend, coming in on one weekend day each week to help run morning report and round with the team; the remainder of the day will be spent providing supervision from home.
This schedule is in abidance with New York State Department of Health Part 405 Regulations as well as the SUNY Downstate Institutional Work Hours Policy and ACGME Program Requirements for Graduate Medical Education in Neurology. Resident work hours never exceed 80 hours per week averaged over a four-week period, including inpatient, outpatient, and educational activities. In addition, residents always have a minimum of 8 hours off between work shifts, and at least one 24-hour period off each week.
Moonlighting is prohibited for 1st and 2nd year neurology residents. Senior residents (R3’s) who no longer do in-house call duties must seek approval from the Program Director and Chair if they wish to moonlight. All moonlighting hours will need to be logged in New Innovations and will count toward the work hours limits above. Moonlighting is a privilege that may be revoked should it interfere with resident learning. Residents on J1 visas may not moonlight under any circumstances.
Residents attend a required wellness session annually to remind them of our various fatigue mitigation strategies and policies. SUNY also provides various online self-assessment tools to address mental health issues such as depression, anxiety, substance use and eating disorders, as well as burnout and compassion fatigue. OBH provides resident on call rooms and relaxation space for use during down-time.
RESIDENT AS TEACHER:
OBH Brookdale is one of the affiliate teaching sites for the Downstate neurology clerkship. Typically, three clerkship students are assigned to rotate at OBH each month. These students work side by side with the residents in the inpatient and outpatient settings, and they will each come in for one weekend on call day shift as well.
Residents are critical to the success of the Downstate clerkship experience at OBH. As such, there is formal training to ensure residents know how to teach. Dr. Merlin is not only the OBH program director; she is also the Downstate Neurology clerkship director, so she has a vested interest in ensuring that the relationship between Downstate students and OBH residents is a mutually-beneficial one from an educational perspective. Residents will help students hone their bedside neuro exam skills, and will also provide students with feedback on their performance at the midpoint of the clerkship. We depend on the residents to inform us of each student’s level of participation in caring for patients with the clinical teams. Residents will provide feedback on student performance in the six competencies, just as we evaluate the residents in those same competencies.
Scholarly activity will be expected of every resident. This activity may take the form of publications and presentations related to quality improvement projects, clinical trials, and case reports. Research related to innovations in educational approaches and assessments will also be encouraged.
Program Director: Lisa R. Merlin, MD
Dr. Shabana Azam
Dr. Ketevan Berekashili
Dr. Gary Friedman
Dr. Arthur Kay (APD)
Dr. Amit Khaneja
Dr. David Lerner
Dr. Artem Sunik
Dr. Ambooj Tiwari
Dr. Daniel Rosenbaum (Chair)
Other Key Faculty:
Dr. Yaacov Anziska and Dr. Katherine Mortati
Class of 2025 – Srikanth Adidam Venkata, Daniel Atashsokhan, Muhammad Irfan Iqbal, and
Class of 2026 – Helene Clervius, Shadi Ghourchian, Mohammad Jadidi, Iryna Mitelman, and