Faculty supervisors:
- Dr. Matthew Schelke and various faculty
Introduction
Welcome! This is your continuity clinic experience in Ambulatory Neurology. This is an exciting opportunity to take full ownership and responsibility for your outpatients and develop skills and practice style in a supervised setting. You will have exposure to a broad range of neurological diagnoses in a unique patient population and the opportunity to learn from our outstanding faculty who are both general and subspecialty-trained neurologists. Neurology itself is predominantly an outpatient specialty and we receive referrals from across the medical center. Our department has the distinct advantage of representation by faculty who are leaders in general neurology and across the subspecialty disciplines, including epilepsy, neuromuscular medicine, movement disorders, behavioral neurology and headache. At Columbia, the Resident Ambulatory Clinics have been completely merged with the faculty practice so trainees will see all patients alongside faculty members in the Neurological Institute.
Location
All patients will be seen in the Neurological Institute at 710 West 168th Street, New York, NY 10033.
Patient Population
We have a unique patient population, including patients from Northern Manhattan and the South Bronx, the greater New York Metropolitan and Tri-State areas, and a few patients from across the country and world who come to Columbia to seek the expertise of our physicians. Many patients are from the Dominican Republic and speak only Spanish. In-person translators can be arranged (best if done ahead of time), and there is always access via telephone to a live translation service through Pacific Interpreters (many residents use this option with speakerphone). The patients are referred from other Columbia NYP ambulatory clinics, community practitioners, and patients discharged from the ER or inpatient services.
Resident Education
As part of your residency training in Neurology, you will learn about the diagnosis, treatment and management of common and uncommon neurological diseases. This is your opportunity to learn how to evaluate common outpatient neurological chief complaints, as well as to follow patients’ disease progression and response to treatment over time. Residents will see patients both in-person and via telemedicine, and will learn how to evaluate patients in both these contexts.
As part of our broader merger of trainee clinics with the faculty practice, residents will be paired with a general neurology faculty member for all three years of neurology training, along with two different subspecialty neurologists which rotate each year. This allows residents to have a three-year longitudinal experience in general neurology, and one-year longitudinal experiences in 6 different subspecialties.
Time Commitment
You will spend one week per month in clinic, during which you will have four continuity clinic sessions (half-days). Between clinic weeks, you are expected to be available to respond to patient care needs on all rotations except vacation, night float, and the neuro-ICU. You will be assigned a “clinic team” of residents who help to cover patient calls and messages when you are away.
Academic Goals
By the end of your neurology residency, we expect that you will be able to recognize, diagnose, evaluate and manage the treatment of patients with common and uncommon neurological problems in the outpatient setting. In addition, in the current ever-changing environment of healthcare practices and economic considerations, you will learn how to communicate effectively with patients and referring providers (verbally and in the electronic medical record), how to practice cost-conscious neurology, when to refer patients for outpatient diagnostic tests and how to complete a neurologic evaluation via telemedicine. To achieve these goals, you will be expected to meet specific training-level appropriate goals in patient care and medical knowledge. In addition, as part of this training, you will be expected to meet the ACGME core competencies (summarized below). With each PGY level you will be given graduated levels of autonomy in the care for patients with the goal to demonstrate at the completion of the PGY-4 year readiness for the independent practice of neurology. The unique patient population which our clinic serves includes ethnic minorities and both uninsured and underinsured patients with limited access to health care. This enables you to contribute to reducing health disparities through opportunities for QI projects to this end.
Evaluations/Feedback
Verbal feedback will be provided in an ongoing, impromptu basis during discussion with faculty about specific cases. Additional verbal feedback will be given after presentations on topics or of exam findings when given by a resident during clinic. Written evaluations using MedHub on resident performance, based on the ACGME core competencies, will be completed by the core clinic faculty on a bi-annual basis
You will have the opportunity for anonymous written evaluations of the clinic experience, director, attending’s and staff on a quarterly basis.
You can also provide verbal feedback during your quarterly meetings with the Program Directors. Ongoing feedback, questions, problems and concerns are always welcome.
Basic Expectations
Clinic start times vary depending on your faculty mentor, but generally begins promptly at 9:00 AM for morning sessions and 1:00 PM for afternoon sessions. Plan to arrive 10-15 minutes before the first patient scheduled to ensure you have time to begin seeing the patient promptly at their scheduled appointment time. You will have 1 hour to see a new patient and 30 minutes to staff with the attending and see the patient together; for follow-ups, the times are 30 minutes followed by 15 minutes review time. All notes must be finalized (including attending co-signature) within 24 hours of the visit, so ideally plan to finalize your notes by the end of the clinic day.
Clinic Call
Each resident is responsible for their own patient messages during clinic weeks and during other rotations except vacation, night float, and neuro-ICU. Messages should be addressed within 48 hours of being sent, so please be vigilant about checking your in-basket and responding promptly to messages! You will be part of a clinic pod of three to four residents who can help cover messages if you are away. In addition, there is always a resident assigned to urgent call for the clinic (24hours/day, 7 days/week) for urgent medication refills and clinical questions.
HAVE FUN! We are here to learn and to take care of our patients. Take ownership of your patients; many patients think of YOU as their doctor and rely on you. Clinic can be a challenging place to work and to accomplish all your goals with a limited amount of time, space and resources. But we can all work together and do our best. Ask questions and be curious- you can learn something new from every clinic session.
Topics in Ambulatory Neurology
- Symptoms
- Lower back pain
- Headache
- Dizziness
- Tremor
- Pain
- Gait dysfunction
- Vision loss
- Memory loss
- Diseases
- Headache-migraine, trigeminal neuralgia, etc.
- Radiculopathies-lumbar and cervical
- Peripheral vertigo-BPPV, Meniere’s, etc.
- Neuropathy
- Myasthenia gravis
- Multiple sclerosis
- Epilepsy
- Post-stroke care and secondary prevention
-
Movement disorders-PD, ET
-
Dementia
-
Concussion
-
Functional neurological disorders
Matthew W Schelke MD
Columbia Neurology
Updated 7/21/25