Neuro-Psychiatry Residency

"To know the brain…is equivalent to ascertaining the material course of thought and will, to discovering the intimate history of life in its perpetual duel with external forces.” 
- Santiago Ramon y Cajal

Welcome to MUSC Neurology/Psychiatry!

Why both neurology and psychiatry? It’s a question all of us are familiar with, and it’s not unwarranted; combining both does add two years to residency. While all of us have different interests and reasons why we have chosen this path, we all agree that having a comprehensive understanding of the brain will improve care for patients and better lead to advancements in neuroscience.

Our residents and graduates have tackled this in various ways. Prior graduates have gone on to use their combined skills in movement disorders/DBS, epilepsy/treatment of nonepileptic events, and brain stimulation. Others have gone more into education or into other subspecializations, such as neurocritical care. Our current residents are interested in movement disorders, cognitive disorders, epilepsy, and addiction.  

What does our program look like?

In our old system, we had a year at a time of neurology and psychiatry. Given our value of interrelatedness between the specialties, we have been working on a new system that allows for more integration. This breaks down as follows:

Intern year:

We value giving our residents exposure to neurology and psychiatry in Intern year while still meeting the GME internal medicine requirements for neurology residency.

Medicine	Neurology	Psychiatry
MICU, cardiology, 3 months general internal medicine, ER, 2 months medicine electives (currently nephrology and palliative care)	General Neurology wards Stroke wards	VA inpatient ward Inpatient Child ward vs Inpatient adult ward at IOP

Second year:

Three month blocks of neurology and psychiatry.  Residents also start their neurology continuity clinic at MUSC or the VA.

Neurology	Psychiatry
1 month general wards 1 month stroke wards 1 month VA wards 1 month child (may be completed PGY2 or 3) 3 weeks night float 2 elective blocks (3-4 weeks each) 2-4 weeks NSICU	1 month inpatient consults 1-2 months night float 4-5 months inpatient wards (combination of General Adult, Acute Care, Addictions, Senior Care, VA) Inpatient child ward in place of an adult ward if not done in intern year

Third year:

Residents continue their weekly neurology continuity clinics. Breakdown is the same as PGY2, but electives/inpatient wards will vary to make sure that residents get a reasonable scope of experience.

At the end of PGY3, residents will have completed requirements for PGY2 years in both neurology and psychiatry. This amounts to 2 months gen neuro, 2 months stroke, 2 months VA wards, 6 weeks neuro night float, 4 weeks NSICU, 2 months inpatient psych consults, 3 months psych night float, 1 month child wards if not done as an intern, and 8-9 inpatient psych ward months. In PGY 2 or 3 residents also rotate through our STAR program at the VA for a month, which is their outpatient addictions program.

Fourth year:

Residents continue their weekly neurology continuity clinics. The first half of the year is spent as a neurology upper level with primarily inpatient requirements. The second half of the year segues into outpatient clinics for psychiatry.

Inpatient neurology requirements include 1 month general wards, 1 month stroke wards, 1 month inpatient consults, day float (BAT and consult coverage during the day), child neurology, 2 weeks of night float, 2 weeks of wellness/education, and a few weeks remaining elective time.

For all psychiatry residents, there is a year of continuity clinics that include general adult, pediatric clinics, geriatric clinics, community mental health clinics, and therapy clinics. We start in January, alongside our medicine/psychiatry cohorts. For the second half of the year we continue our neurology continuity clinics as well.

For residents interested in participating in our DART research program, this is the year many apply. Residents have been able to work with our program directors to coordinate starting this program earlier as well.

Fifth year:

Residents continue with their psychiatry clinic requirements. They may choose to keep their general neurology continuity clinic or drop it this year (three years is the requirement for neurology residency). There is opportunity to integrate some neurology clinics or research time as well. If a resident is participating in DART, there is required lecture time and protected research time as well.

This is also the year people will start applying for fellowships if they are looking to further subspecialize.

Sixth year:

Having completed inpatient and outpatient requirements, this year is open for research/elective time. As long as there is a balance of psychiatry/neurology clinics to fulfill graduation requirements, the options are fairly open. In the past residents have participated in consult services, DBS implantation/planning, or running nonepileptic event specific clinics, for example. 

Education opportunities:

We participate in lectures depending on which department we are working with. Neurology has lectures every day at noon, morning reports on Tuesday and Wednesday, and professor rounds (where an attending discusses a case with the inpatient teams and residents will go see the patient with the attending). Psychiatry has one lecture day a week, with psychodynamic lectures and more generalized lectures. Once we start doing clinics for psychiatry, there is one day of supervision as well.  

Outside of regular lectures, there are several opportunities for additional education. Every year, our neurology department has a research day, where we get to present current projects or case reports. Our neuropsych PGY3, Manish, and one of the other PGY3 psych residents (Eric Dobson) run a psychedelic science journal club monthly.  

Coming in the future, we are aiming to have a neuropsych journal club as well. This year my goal is to have us meet up at least quarterly to talk about a current topic in neuropsych, but to also touch base with our residents as a group and make sure everything is going well.   

Sound interesting? We recruit 1 resident a year and we are excited to meet people who love the brain as much as we do!  If you have any other questions, you can feel free to contact:

Manish Karamchandani
PGY6 Neurology/Psychiatry Resident
karamcha@musc.edu