Students will contribute to the care of those admitted for a variety of acute and serious neurological problems.
Students will divide their time between General Neurology and Stroke Services to gain broad exposure.
Typical diseases will often include ischemic stroke, hemorrhage, infection, seizure, encephalopathy, intractable neurological pain, inflammatory neuropathy, and demyelinating disease.
Stroke and General Neurology are two separate services located on 11400/11500.
An Attending and Chief Resident leads each service, with 4 junior residents. Thus, the entire inpatient adult service consists of two attendings, two chiefs, and eight residents.
Call every 4th night. Two residents on-call per evening, one each from Stroke and General Neurology.
Residents leave post-call after their patients are presented – typically ~10:30am.
Daily admits will be distributed as “shorts” to the post-post-call team and the pre-call team. Patients go to the overnight call person beginning at 5pm, but may start earlier if the slots for daily admissions fill.
New patients come from the emergency department, transfers from outside hospitals, direct admissions from home or clinic, transfers from the NeuroICU, or transfers from other services in BJH.
Patients admitted to the ward service will be presented to the attending and chief typically the next morning. Patients can also be admitted to a faculty member’s own service, with patient coverage by a nurse practitioner or resident.
When your resident leaves for the day, those patients are “signed-out” to the on-call person. When a resident returns the next day, they check with the on-call person for any events.
A master list of patients with updated active problems and to-do list is kept on the computer. You should obtain this list to help stay pro-active and engaged on rounds.
You should always have patients to follow. Begin to assume care for several patients on day 1.
Team Teaching Rounds
Key time to learn about patient care, observe the neurology history and physical, present patients, and interact with the team and attending.
Stay on rounds while new patients are being presented. Students should typically be excused from rounds when the post-call team leaves ~10:30am.
Rounds typically (check with your resident) start in the 11400 conference room at 7:30 AM on M/Tu, 8:15 AM on W/Th, 9:15AM Friday if there is Grand Rounds or 7:30 AM Friday if no Grand Rounds.
Remain engaged and attentive. At bedside, try to get close to attending and patient to see exam findings.
Patient presentations should be concise, pertinent, prepared, and no longer than 5-10 minutes.
Always start with neurological problem-based chief complaint.
DO NOT READ FROM YOUR NOTE. Prepare an index card with a brief outline of the salient aspects of their history and exam.
ROS and FH are usually not important for a focused presentation.
General medical exam should be abbreviated in your presentation (ie. ‘General exam was normal. Notably, there was no…
The neurologic exam should also be abbreviated where appropriate (i.e. mental status and cranial nerves were normal).
Your assessment should include localization, a prioritized differential, and a plan for investigation and treatment.
Key time to get updated on all aspects and progress for your patients.
You must pre-round on all your patients, even if you have conference before rounds.
Check with your resident or the post-call resident for any interim events.
Review vital signs, blood sugars, and notes from nursing, PT/OT/Speech, Social Work/Case Management.
Check the computer for labs, test results, and finalized radiology reports.
See the patient for a pertinent history and exam.
Check with nurse for any events or concerns.
Review the chart for event notes, consultant recommendations, and changes in orders or medications. Check medicine list to see if anything was withheld.
Check telemetry for events.
Finish your SOAP note and update with the most accurate information.
Review daily orders for your patients.
Prioritize and complete tasks on your patients.
Work-up or pick-up new patients.
Aim for 1 patient on regular day, 1-2 patients on long admission day.
Maintain a census of 3-5 patients at all times.
Work with everyone on your team to admit patients.
Latest to get new patient is 4:00 pm on regular admission day, 7:30 pm on a long admission day.
Seek new patients as soon as available from your resident.
Work-up patient and page resident to discuss after collecting your thoughts.
Incorporate resident discussion into note and upcoming presentation.
Read about patient’s diagnoses and solidify your assessment and plan.