The Pediatric Neurology rotation occurs several times over the course of your residency and typically is 4 weeks in duration.  During this time you will operate as a resident on the Pediatric Neurology service.  Therefore, you are not required to attend Adult Neuro morning report.  However, you will come to some of the conferences that are shared between the two services.

 

Rotation supervisor is Ju Tang  

 

This is a mandatory rotation, and while on it you cannot cover for other residents on other rotations.

 

Report Day 1 at 8:00 AM to Floating 1, Pedi Neuro Clinic

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Pediatric Neurology Rotation
 

• If you are not on call:

• Rounds begin at 9 am. If you are following an inpatient then the expectation is for you to have rounded on your patient before rounds. 

• After rounds, finish your notes. Help with medical students notes/teaching

• Touch base with on call fellow to see if they need help with anything

• Afternoon you are expected to see at least 3 clinic patients

• All patients are first seen by a medical student or resident and then staffed with the clinic attending

• Thus the number of patients you will end up seeing each day depends on the number of medical students on the rotation for that month

If you are on call:

• Pediatric Call schedule is released 3 months in advance and is typically on Google Drive. If not, then contact the Pediatric Fellows to ask them to forward it. 

• Call starts on Friday 5 pm

• All calls from concerned parents, surrounding PCP's, and off hours clinic concerns/questions are paged to the on call pediatric fellow

• Most concerns are relatively easy to manage, however if you ever have a question you are free (and expected) to text the on call Pediatric Attending

• For example: a father calls stating his child had a 6 minute seizure and is still post ictal. 

• You should advise them to go the nearest ED for basic lab and infectious work up and ensure they get their medications, etc given prolonged seizure 

• You should text or notify the on call attending. 

• You should send a jellybean to the primary pediatric neurologist

• Frequently will get pages from PCPs asking for an urgent appointments. 

• There are typically three urgent appointment slots a day. 

• If you feel an urgent appointment is warranted then let the secretary know, and they will coordinate it

• You will also receive pages from nearby Emergency Departments asking how to manage a patient as Pediatric Neurology is not readily available in community hospitals

• Retrieve a detail history: including birth, perinatal events such as a NICU stay, precipitating events for seizures (sleep deprivation/traveling, missed dose, infection, etc). Details of seizure. 

• If they are a Tufts patient, review their chart

• Call/Text/Page (depending on attending preference) the on call attending and staff the patient

• Call back to the ED and convey recs

• There is no inpatient pediatric neurology, thus all patients are admitted to general pediatrics, so expect pages from inpatient

• The pediatric residents are quite familiar with Neurology admissions, so fortunately we are not paged often. The most common things would be refractory seizure management so make sure you familiarize yourself with established Pedi Neuro seizure protocol

• Rarely, are you needed to come in house to manage a consult. Most ED consults will be for seizure (breakthrough vs first time), headache, and concussion, which can be managed over the phone.

• Any consult discussed over the phone should be seen in person the next day to be staffed

• Typical Weekday Schedule

• Rounds are at 9 am, but you should pre round on all of the patients (including the ones following by the other residents and the medical students as you are the team leader)

• You lead rounds

• Medical students can present the history and exam

• You present the imaging and the attending will go through the EEG

• After rounds you finalize notes and help medical students

• As you are on call, it is your responsibility to teach the medical students during rounds as well. They will forward their notes to you typically so make sure you go through the notes and send them feedback as they are there to learn

• Rest of the day is open to manage new consults

• Get the history and if a medical student is free then you are able to hand the consult to them and co-manage

• Notify the Pedi Neuro attending you are ready to round

• Make sure to close the loop and convey recommendations to the Pediatric team

• Will also frequently have 1 or 2 LTM admissions as well, which arrive in the early afternoon and stay for 1 or 2 days

Thursdays are educational days:8 am: Morning Report, where an interesting patient is presented

• 9 am: Rounds

• 10 am: Pediatric Neuroradiology rounds (the on call resident is to put together a list of patient over the week and email it to the NeuroRad)

• 11 am: Lecture

• Thursday afternoon is fellow continuity clinic

Overall, the Pediatric Neurology rotation is a great deal of fun and you are given plenty of opportunities to learn and time to read. Call is not necessarily stressful but cumbersome as you have to carry your pager with you at all times and may get paged in the middle of the night occasionally. Go in with an open mind to learn as much as you can and be eager to help as the pediatric neurology fellows help us when they rotate through adult neurology and you will definitely have fun.

 

 

Child Neurology Operation Manual 2017

Re: Adult Neurology Resident

 

This manual is to be used as a guide for the roles and responsibilities of the Adult Neurology Residents on the Child Neurology rotation. If, at any time during the rotation, there are questions or concerns, please contact the rotation director, Dr. Ju Tang. The child neurology program has an open door policy for all attendings to discuss any topic when needed in order to continually improve our program. 

 

Please email Dr. Tang, Dr. Kornbluth, the child neurology attending and fellow on service, as well as the adult neurology chief if personal time is needed during this rotation.

 

GOALS:

-Learn the pathology of common pediatric neurology disorders

-Learn the details of the pediatric neurologic exam

-Learn the fundamentals of EEG

-Prepare for the pediatric neurology portion of the neurology boards

-Practice the skills needed to be a team leader (med students, residents)

 

Adult Neurology Resident Requirements

Total time required: 12 weeks cumulative throughout the residency (9 Outpatient weeks + 3 inpatient weeks).  Most rotation blocks will be 2 weeks or more to help establish the expectations of the rotation. The day typically starts at 8am and ends around 5pm. Adult residents will be expected to be present all day except for their continuity clinic. You are expected to attend Child Neurology’s Didactic Lecture Series on Thursday’s and you will be required to do one 40 minute presentation on a topic of your choice during the rotation.

Plan to meet with Dr. Tang on Day 1 of the rotation for orientation and when to set up periodic reviews.

 

9 Clinic weeks (non-call weeks)

During these weeks the primary responsibility will be caring for clinic patients

-       The clinic starts at 8am (after adult neurology morning report) and ends around 5pm, with most noon hours left open to allow for attendance of conferences.

-       There may be additional learners on the rotation, but you will be expected to see at least 3 patients in AM and 3 patients in the PM clinic.

-       Assign yourself to the patients on ECW the night prior to clinic (Friday night before Monday clinic) to notify attendings which patients you plan to see

-       Staff with attending after seeing each patient and complete note within 24hours.

-       If no clinic patients are scheduled, you will join the service team and assist with consults as determined by the senior team leader

-       Adult Neurology resident will assist with covering the service pager during the service fellow’s continuity clinic (Monday or Thursday afternoon) or when needed as determined by the service fellow.

-       Adult Neurology Resident will work directly with rotation director Dr. Tang on Friday (if she has clinic), except the Fridays that you are on call.

 

3 Service weeks (call weeks)

Call weeks will be interspersed throughout the 12 weeks. When on call you will take the role of the fellow and run the pediatric neurology consultation service. It is important to learn the fellow role while on your clinic weeks.

 

Consultation service

Basic rules

• -       Required to carry Child Neurology Consult pager for 1 week (5:00 PM Friday to 5:00 PM next Friday)

• -       Responsible to attend and return all the pages timely while on service

• -       Required to update and maintain a detailed inpatient sign out using Web Box service

• -       All consultations (physically or phone) should be discussed with attending with full information available at that time.

• -       Adult Neurology Resident should either talk to attending in person or over the phone on all consultations. Text can be used to contact attending prior to call, but is not sufficient to discuss the case and review treatment plan.

• -       All communications, such as with attending and primary care team, should be documented in eCW or Soarian.

• -       No curbside consults. We can assist with outpatient scheduling by directing to nurses and office administration, but if service is asking any management questions, we need to do a full consult. 

 

Week of house call and service

Morning:

• -       Adult Neurology Resident on call must pre-round all patients under the service.

• -       Additional team members must pre-round on their assigned patients, complete their note and be ready for presentation during the round by 9 AM (Thursday by 8AM).

 

During the day time:

• -       See new consultations. If emergency, attending can assist with triage of the case based on clinical priority.

• -       Should coordinate consults with other residents and students

• -       Keeps abreast of all inpatient issues and discusses plan with pediatric team

• -       Assist with teaching of medical students and residents

 

  Evening:

• -       Adult Neurology Resident is the primary person to respond to the pager after 5:00 PM: typically home calls (you may called in by ED and floor in person occasionally PRN new consults; otherwise, you may provide verbal recs and see the overnight consults in early AM the following day. PED attending available overnight PRN critical questions)

• -       Attending will be available to supervise

• -       Adult Neurology resident needs to come in to the hospital within 2 hour, if requested depending on the acuity of the case.

• -       Resident should report and discuss all overnight phone calls with the service attending in the following morning, if not reviewed overnight.

• -       Thursdays Special Schedule [8AM-12 PM: PED Didactics, 12:00PM-1:00PM: Lunch, and 1:00-5:00PM: PED Fellow Clinic]. AM Details: 8:00-9:00 AM: sign out to new attending/team, 9:00-10:00 AM: Tufts Grand Round, 10-11: PED Neuro-radiology cases conference, 11-12: PED EEG or lecture TBD.

• -       By Wednesday 5:00 PM: you may be required by the PED fellow on service or the PED attending to schedule and finalize Thursday PED schedule as above.

• -       During the Thursday Core Lecture, Nurse Practitioner/ Attending will cover the fellow pager

  

Signing out the service

If you have adult continuity clinic then the pager (12-5PM) should be covered by the PED fellow, PED attending, or other resident, if any, on service

1.    Signing out cases for transfer of care

a.    Adult Neurology resident to prepare written sign out when on service

b.    Adult Neurology resident to Fellow sign out (verbally)

c.    Attending to attending sign out (verbally)

  

Medical records

1. Clinic notes must be completed within 48h and sent to the supervising attending.

2. Consult note should be completed in Soarian

3. Date and time.

4. Vital signs, weight, height.

5. Head circumference for all patients <=2 year old

6. Document all sections including ROS.

7. Fellow/resident/student are responsible to reconcile medication list

8. Check off confirmation for each subjects

9. Document patient guidance (seizure precaution, acute seizure plan, headache prevention, etc.)

10. Clinical studies: Adult Neurology Resident should directly review every CT and MRI on each patient and should not solely rely on reports of these studies.

11. Record any patient-physician, physician-physician, physician-assistant, physician-pharmacy, etc., communications in eCW (preferably Telephone encounter). Assign telephone encounter (T jelly beans) to the primary neurologist (attendings, fellows) so the information will be passed to them.

12. Please enter all medication changes or new medications into eCW after discharge

13. Any medication changes should be documented in eCW (preferably with Telephone encounter and updating medication list). Assign telephone encounter (T jelly beans) to the primary neurologist (attendings, fellows) so the information will be passed to them.

14. Preferable to establish remote access from home.

 

 

Admission

1.  Call charge nurse and admitting office to secure bed (may walk up to the floor to meet with charge nurse and the floor senior resident).

2. Call Admitting 66200 and give information about patient

3. Call senior resident in the floor to sign out the patient.

4. Attending will sign out to the floor attending to sign out the patient.

5. Make sure the consult note (admission note) is completed and put into Soarian

 

Teaching

1. Attend to all mandatory, routine conferences/lectures (Neuroscience Grand Round, Neuroradiology round, Core lecture series, Neuro/Psych/Development conference, Epilepsy conference)

2. Prepare to teach medical students and residents, as well as a 40 minute presentation on a topic of your choice.