Basics

A typical Tufts night is 2-3 consults. 

Pagers: 6500 (consult), 2038 (floor), stroke codes (come automatically to personal pager and coverage pagers, so you'll get multiple pages). 

Hours: 7pm sharp (try to be a little early) to 8-9am. You have to stay late for morning report on Mondays, Wednesdays, and Thursdays, and most other days the attending will make you stay to sign out every patient in detail in person.

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Workflow/Schedule

Arrive at 7pm. Print your list. Get signout from the long call resident. Sign over the pagers. 

You're the only neurologist in the hospital at night. You're responsible for covering all the neurology inpatients, new ED consults, new floor consults, floor/NIMC or ICU admissions, stroke codes, and new ICU consults. 

Most consults are staffed with the senior resident - floor, ED (whether or not they're stroke questions), ICU. They're also your first call for issues with the inpatients. 

Stroke codes are staffed with the ward attending or the stroke fellow (not the stroke attending).

NCCU admissions are staffed with the NCCU attending (big strokes, status epilepticus, etc.). If you admit to the NCCU, you should also FYI page 4000 (Neurosurgery/NCCU coverage) about the admission so they can put it on their list. Consults from ICUs other than NCCU (MICU, SICU, etc.) are staffed with the senior resident, not the NCCU attending. 

You may get calls from outpatients - if they have a question or complaint, the response should almost universally be "go to your local ED" unless you're VERY confident that they're totally fine. If they want a refill, it's usually fine to send a few days' worth of anything, but use your judgement. Regardless, make sure you write a telephone encounter in eCW and route it to the patient's primary neurologist (see eCW tips for details)

You may also get calls from outside hospitals, which are typically for one of 3 things:

1. Information on a patient in our system, which you can give.

2. If they want to transfer a patient, tell them they need to talk to the on call attending - we can't accept transfers as residents.

3. If they want advice (this happens rarely), you're not able to give advice over the phone because you haven't seen the patient; if they insist, they can talk to your attending about possible transfer (see #1). Be careful with these people - they will write down your name and put in the chart "Per Dr. BlahBlah at Tufts neurology, given 10,000 mg Keppra, now has drowsiness of unclear etiology" even if it's not true, so it's better to say nothing at all. 

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Morning Report

At both Lahey and Tufts, the NF resident is responsible for presenting at morning report. This consists of presentation of a case from over night (it can be interesting or super simple, there's always something to learn). If you miraculously saw nothing overnight, you can present a patient you've seen recently, or you can present a paper. 

At Lahey, this happens on Mondays and Thursdays. At Tufts, Mondays/Wednesdays/Thursdays. 

The general structure is presentiation of the chief complaint/reason for consult, chronic medical issues/history of present illness, and pertinent history items from SH/FH/meds/PMH/PSH. Faculty will interrupt repeatedly to clarify details from the history, or to ask you about localization or differential. You then present the vitals/exam, and again may be asked a series of questions. 

This presentation process can often seem intimidating, but is in fact one of the best and most important parts of the residency training.  At no other time will your work be considered, mulled, and probed by numerous faculty all at once.  They will often ask you questions to which you don't know the answer.  That is ok, as they are not looking to see how ignorant you are but are looking for an opportunity to teach.   Your job often is to do a focused exam,  what is difficult is know what to focus on, and if you missed a part of the exam that they ask you about, this is not about chastisement, but for you to remember that this seemingly irrelevant exam detail is actually pertinent to the presentation of the patient.