Goals and Objectives:

​

1. Mastery of all aspects of neurological disease prevention, diagnosis, counseling, and management.

2. Development of team leadership skills.

3. Serve as an educator to medical students, patients/families, and junior residents.

4.  Participation in research and academic pursuits.

5. Introduction in healthcare systems and models of care.

​

Senior Expectations:

​

The ward senior rotation is an opportunity for residents to act as a junior attending. The senior resident is responsible for running rounds, leading CAP rounds, overseeing both in the inpatient junior and consult residents, and teaching residents/ students/ rotators. Patients will be examined at the bedside with the expectation that the senior resident will perform bedside teaching and communicate with the patient and families.  The senior is expected to either perform the exam or supervise the junior resident performing the exam. Should either the consult resident or the junior be overwhelmed with work, it is your job to triage, delegate work appropriately, and assist with any work to make sure everything is done in a timely manner, including getting all residents home at reasonable hours. The senior resident should always promote and serve as a role model for a culture of teamwork and collegiality amongst residents, nurses, and PAs/NPs on inpatient team.​

​

Workflow:

​

Monday-Thursday:

​

• Arrive at 7:00 AM for sign out from night float. Sign out occurs from 7:00-7:30 AM.

• Pre-round from 7:30-8:00 AM except on days where there is morning report, grand rounds, or radiology rounds. The senior resident should personally evaluate any unstable patients before formal rounds.

• Formal rounds start at 8:00 AM with the team including senior resident, junior resident, and medical student. Attending may or may not be present at the start of rounds.  The senior is expected to make and implement preliminary plans for all patients.

• The senior resident is responsible for triaging which patients should be seen first on rounds with a priority for patient requiring early disposition planning, unstable patients, and those that the senior feels comfortable formulating a plan independently.

• The senior is expected to run CAP rounds on 6W Nursing Station from 9:15-9:30 AM.

• Senior resident is expected to lead the rounds with attending supervision.  The senior should review final plans with the attending.​

• The senior resident should conduct family meetings in the afternoon.

• The senior should be available to assist the junior resident in the afternoons with discharges, new admissions, unstable patients, etc.

• The senior should be available to the consult team in case help is required.

• The senior should be able to perform the work of a junior resident in time of emergency, in case of illness, or other emergencies.

• The senior resident workday ends at 5 PM on weekdays; however, in cases of emergency, short-staffing, unstable patients, or additional assistance is required, the senior is expected to stay after hours in such circumstances.

​

Friday and the Academic Half-Day:

​

​

• The senior is responsible for ensuring all the work is completed on the Inpatient General Service prior to leaving for the academic half-day on Friday afternoons.

​

Weekends:

​

• On the weekend, the senior is required to round independently on the General Neurology Inpatient service. After enactment of the plan for the General service, the senior must touch base with the junior resident to determine if any assistance is needed. It is at the senior resident’s discretion to leave early if the wards and the work of the junior resident is stable.

• At Lahey, seniors will round with the general attending (without a junior) and are responsible for carrying the general pager and writing progress notes on the general list. When their work is completed, seniors are expected to remain in the hospital until 5pm and assist wherever possible to ensure the junior's inpatient work for the stroke patients is completed. 

​

​

Educational Responsibilities:

​

• Senior residents will be responsible for leading the resident-based didactic session which may include, but not limited to:

  • RITE exam questions

  • Anatomy review

  • Continuum topic

  • Journal article

  • EEG/EMG case sessions

  • Professor Rounds

• Verify that all patient care is completed on the inpatient service including communicating with consultants, ordering and following results of lab/imaging data, lumbar punctures, etc., with an emphasis on autonomy for the junior resident. Assist as needed to optimize workflow. 

• Verify that the consult service is running smoothly and assist as needed including coverage of new consults. 

• Conduct family meetings as needed. It is the primary responsibility of the senior to ensure that the patient and/or family of every patient is updated on a daily basis.

• Ensure signout is updated and progress notes/discharge summaries are completed by PGY2. Ensure that all patient care notes authored by residents at all levels reflect analytical thinking and medical decision making, including diagnostic, therapeutic, counseling and discharge planning.

​

Format for Rounds:

​

• Pre- rounds occur between 7:30-8:00 AM for junior and senior residents.

• Formal rounds start at 8:00 AM. Rounds should always start with any unstable patients.

• The expected members of the team at the onset of rounds includes senior resident, junior resident, +/- medical students/rotators/attending.

• If the attending is present, they are expected to allow the senior to perform the role of team leader, create the preliminary care plan, educate the junior, and counsel the patient.

• The role of the attending should be to addend, add, or correct the senior so that the senior resident can improve the plan differential by using positive feedback.

• Rounds should be completed by 10:30 to 11:00 AM. The senior resident is expected to table round on any patients not seen with the attending immediately after rounds. The junior is to use this time to perform any necessary tasks prior to conference.

• The senior is expected to contact the attending directly in a time-appropriate manner if there are any urgent issues requiring immediate decisions that the senior is not comfortable making independently.

 

For each patient, the following format is recommended:

​

1)  The junior residents present the one-liner on the patient

• Example: “A 34-year-old woman with a PMH of SLE presents with 1 week of double vision. Initial neurological exam was notable for Cogan sign, curtain sign, fatigable extraocular eye movements with dysconjugate gaze and associated binocular diplopia”.

​​

2) The junior presents overnight events, vitals, morning exam findings, and pertinent labs/imaging.

​

3) Senior resident will create and discuss the preliminary plan with the junior outside of the room. If the attending is present, he/she may addend the plan if there are any significant flaws.

​

4) The junior resident performs the physical exam with the supervision of the senior. The senior may repeat or add specific maneuvers and should perform bedside teaching of physical exam findings.

​

5) The senior resident should communicate the preliminary plan with the patient.

​

6) After exiting the room, the senior and attending should provide one teaching point to the resident regarding the case (pathophysiology, treatment, localization, differential, prognosis, etc.).

​

​

•  

• At Tufts, inpatient rounds proceed as usual with attending, junior or consult resident, and senior present. The junior will carry the general, consult, and stroke pagers. The junior will write progress notes on inpatients, and the senior will write progress notes on consults. The junior will see new consults during the day. The senior is free to leave when rounds are complete and they have assisted the junior to the best of their ability.

​

Senior Resident Administrative Responsibilities (Lahey only):

• Select case for Chief's Rounds on Wednesday mornings.

​

​

Tips for overnight calls (Tufts only):

• Write down the MRNs

  • When in doubt, admit

  • If the patient cannot walk, they cannot be discharged

  • Patients don't generally repeatedly come to the ER for the same issue in a short span.  If this is a return visit, lean toward admission, even if only to prevent future ER visits for an ambulatory issue.