The ward senior rotation is an opportunity for residents to act as a junior attending, which comes with all of the rights and responsibilities of a position of leadership.

Responsibilities include oversight and responsibility for the actions of the entire inpatient team, which is comprised of the junior resident(s), consult resident, night float resident, and any medical students or outside rotators. They should be peripherally aware of NCCU patients as well, particularly if they are pending transfer to the floor or step-down units. 

​

Senior expectations:

General:

• Promote a culture of teamwork and collegiality amongst residents, nurses, and PAs/NPs on inpatient team.

• Provide teaching, supervision and leadership to PGY2s. 

• Provide excellent patient care. 

• Should either the consult resident or the junior(s) 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. 

• Serve as the primary communicator for the neurology team when interfacing with patients/families. This means performing the exam on rounds, discussing results of testing, and updating the patient/family on the plan of care. Seniors are also responsible for daily family updates and meetings.

​

Workflow/Time management:

• Arrive at 7am to ensure proper supervision of the signout process and facilitation of pre-rounding (and discussion of any urgent issues) as well as setup for morning report or lecture.

• Ensure that entire team attends morning and noon conferences.

• After morning conference, run the consult list with the consult resident and discuss triage and rounding plan for the day.

• Lead interdisciplinary rounds on the neurology floor.

• Lead bedside rounds - this includes prioritization of patients to be seen based on medical acuity/discharge planning, as well as leading the review of clinical data, examination of the patient, formation of the plan, and communication with the patient/family.

• 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.

​

Weekends

• 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. 

• 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.

​

​

Senior Resident Administrative Responsibilities (Tufts only):

• Introducing neurology grand round speakers at 9 am on Thursday mornings in Wolff Auditorium.

• Organizing and presenting Morbidity and Mortality Conference once each month (on a Friday) at noon in Biewend 12 conference room.

• Organizing and presenting Vascular Conference once each month (on a Friday) at noon in Biewend 12 conference room/library.

• Designating appropriate patient cases for Sabin Conferences on Tuesday, Wednesday and Thursday 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.