A Day in the Life of a Resident

A Day in The Life of a Neurology Inpatient (IPD) Resident

As a resident on the neurology inpatient service, we are responsible for caring for all acute inpatient neurologic conditions. This can include pathologies such as stroke, seizure, status epilepticus, myasthenia gravis crisis, multiple sclerosis exacerbations, acute inflammatory demyelinating polyneuropathy (AIDP) and its various subtypes (GBP, AMSAN, AMAN, etc.), chronic inflammatory demyelinating polyneuropathy (CIDP), status migrainosus, encephalopathies (autoimmune, paraneoplastic, etc.), among many others. We have three floors of patients, two of which are ICU step down units where stroke, seizure, and higher acuity patients are cared for, and one of which is our general neurology floor.

A large team cares for our neurology patients, including an attending staff physician that rotates on service weekly, 2 advanced practitioners, 1 senior resident, 2-4 junior residents, and typically 3-4 medical students. We also have our buddy night float system (1 senior resident and 1 junior resident) that take care of our service at night. Having such a diverse team provides many opportunities for learning from multiple staff and co-residents, as well as teaching junior residents and medical students.

The senior neurology resident on the team is partly stepping into the role of junior attending. He or she is responsible for overseeing the entire list, dividing patients for the junior residents, going over differentials and plans with junior residents prior to running the list with staff, and helping to facilitate care for all patients in a timely manner. The junior neurology residents on the team will be responsible for directly caring for their own patients, typically between 5-8 patients daily. They are expected to chart review, round on their patients, and come up with daily plans (assisted by the senior resident) prior to running the list with the staff in the morning. They will present each case to the staff for discussion, review images, and finalize plans. The afternoons are typically spent writing notes, ordering tests, and performing any required procedures (lumbar punctures, etc.). The junior neurology resident on call will take the consult pager at 3:00 PM and see consults until 7:00 PM. The senior neurology resident will stay on the floor until 7:00 PM when night float arrives. They will sign out the patients to night float until 7:30 PM, after which the night float team takes over both the floors and the consult pager.

Typical Timeline of the Neurology Inpatient Service:

• 6:00-7:00 am: Residents arrive in the work room to chart review and pre-round on patients
• 8:30–11:30 am: Staff arrives in the work room to round on all patients, discuss images, and finalize all patient plans for the day
• 11:30 AM–12:00 pm: Write any quick orders or call consults that are urgent; grab lunch 
• 1:00– 5:00 pm: Round on any patients not seen yet; work on notes, order tests, facilitates patient care, and speak with families etc.
• * On Tuesdays, from 12:30 - 4:30 pm there is protected time for Academic Half Day

A Day in the Life of a Neurology Consult Resident

As a resident on the neurology consult service, we see patients in every department of the hospital, including the emergency department, internal medicine floors, surgical subspecialty floors, and even the obstetrics and peri-partum unit. We respond to neurologic emergencies, such as stroke and status epilepticus, and help manage a wide array of other neurologic conditions in patients with underlying medical co-morbidities. We look at the patient's history, carefully review their current hospital course, and do a thorough neurologic exam to formulate a differential diagnosis in order to recommend further work-up and management.

Days on the consult service can vary depending on the number and type of consults that we receive. The consult team carries the consult “pager” from 7 AM to 3 PM, and is responsible for seeing any consults that are requested during that time. The team is made up of 2 attendings, 2 senior neurology residents (PGY-3 and PGY-4), 1 junior neurology resident (PGY-2 or PGY-1), and several rotating residents (usually from the internal medicine, family medicine, psychiatry, radiology, and emergency departments). The day begins by "running the list" and deciding which follow up patients need to be seen that day, and dividing the new consults to be seen amongst the residents on the team. The resident assigned to a particular patient will chart review and examine the patient, and then will present the case to the attending physician. We then discuss the case and attendings provide guidance and additional teaching points.

As a senior resident on the neurology consult service your duty is to lead the team by receiving consults, reviewing all patients and distributing them amongst residents, assisting with formulation of plans, as well as teaching of junior residents and medical students. The junior neurology resident on service is responsible for seeing stroke pages throughout the hospital and in the emergency department, in addition to seeing other routine consults as time permits.

Typical Timeline of the Neurology Consults Service:

• 7:00 am: Meet in the neurology work room to chart review follow-up and new patients, as well as prepare the patient list for the day
• 8:00 am: Table rounds with the whole team, including attending physicians. We will discuss any follow-up patients, review images, relevant labs and make a list of new consults to see
• 8:45 am-12:00 pm: See new consults from overnight and urgent follow-ups and new consults from the morning.
• 1:00- 1:30 pm: Regroup in the work room to discuss remaining consults to be seen, follow up on any tests that had been ordered
• 1:30- 3:00 pm: See remaining consults and any new consults
• 3:00 pm: Consult team hands off the pager to on-call resident. The on-call resident will see all new consults placed after this time
• 3:00-5:00 pm: Finish seeing any remaining consults for the day, finish notes, and run the list with the attending to go over final plans and recommendations
• * On Tuesdays, from 12:30 - 4:30 pm there is protected time for Academic Half Day

A Day in the Life of a Neurology Outpatient (OPD) Resident

The outpatient clinic month is a great time to immerse yourself into outpatient life and to get a feel for what working in an outpatient clinic full time might feel like. You are responsible for seeing patients assigned to you, going over plans with your attending, and then explaining to your patients what diagnosis you think they might have and how you plan to address their concerns. Working one-on-one with your attending to discuss each case, come up with differentials, and formulate a plan is an invaluable opportunity to learn outpatient neurology in individualized, hands on fashion. Your attending will change week to week, affording the ability to gain different insights, perspectives, and approaches to various neurologic ailments as they guide you in treating your patients. Additionally, you will be responsible for ordering tests and following up on those results, sending results to patients, calling patients on the phone to discuss critical or abnormal results, and to answer any questions they may have after their appointment with you. You will have your own Epic In-basket to help keep track of all of your messages and tasks.

Typical Timeline of the Neurology Outpatient Service:

• 7:30-8:30 am: Patient 1
• 8:30-9:30 am: Patient 2
• 9:30-10:30 am: Patient 3
• 10:30-11:30 am: Patient 4
• 12:00–1:00 pm: Lunch and attend noon educational lecture for all neurology residents
• 1:00-2:00 pm: Patient 5
• 2:00- 3:00 pm: Patient 6
• 3:00-4:00 pm: Patient 7
• 4:00-5:00 pm: Wrap up notes and take care of in-basket messages, etc. (PGY-2)
• *Half a day of administration time
• * On Tuesdays, from 12:30 - 4:30 pm there is protected time for Academic Half Day
• * Additionally, clinics are typically blocked off for an hour for Grand Rounds