I will say that neuro was the most physically taxing service that I had during my 4th year. After neuro everything seemed easy, or at least manageable.
# of Students: 2-6, but most likely 3-4
# of Residents: 2-3
# of Faculty: 1-2
And some fantastic techs to help you with just about anything & everything!
Hours: 6:30am-10pm (if you’re not on call for that evening)
Rounds: Neuro rounds are daily at 9am, which means you spend 6:30am-9am doing morning treatments on your in-patients. Most rounds are case rounds where you go through and update the group on current inpatients and plans for them. Topic rounds may or may not happen. We had them a few times during my rotation, where we went over a few big topics, such as seizures, but they are the first thing to go if time is limited as they would rather make sure everyone is updated on what’s going on with each patient than go in depth on a given topic.
Caseload: Expect to see 1-2 new cases per day during the day on top of managing anywhere from 2-6 inpatients at a time. If you’re on call…well…see “On Call” below…
Your Role: Get a good history from the clients and do a thorough physical examination. Present the case to the resident outside of the room and brainstorm differentials and possible diagnostics. The resident and you will then perform a neuro exam on the patient either in the room with the client or in another location. Discuss plan with resident and clients. Admit patients and care for them while in the hospital, performing all treatments between 8am and 8pm with tech assistance if needed.
On Call: At the beginning of each week, students sign up for evening and weekend on call shifts. Weekdays there is a primary and secondary student and weekends there are primary and secondary students for both day and evening shifts (10 shifts per weekend, including Friday night). You will have a lot of on call shifts during your rotation and expect to be called in (or not even leave the hospital because the emergencies came in during the evening before you even had a chance to leave). Always have food available to scarf while you are at school, and always have enough food for a full 24 hours if you are on call. Some students have spent 24-36 hours at a time in the hospital without sleep on this rotation, so be prepared!
Records: You are responsible for history, physical exam & neuro exam, daily SOAPs, discharge instructions and summaries. Some residents help with records more than others, but I personally never felt that the records were a burden while on neuro.
Weekends: Don’t expect to see much of your weekends while on this rotation. You will likely have inpatients and they will require treatments at 8am & 8pm. I managed to discharge all of my inpatients the Friday/Saturday of my last weekend on neuro and still showed up to help my classmates with their treatments. It’s a team effort.
If you’re on call…well…see “On Call” above…
- You will learn how to perform neuro exams by the end of this rotation and localize lesions appropriately! That is a huge pro!
- Lots of hands on, except for in surgery.
- It’s incredibly rewarding to have patients that come in unable to walk and leave walking or well on their way to walking.
- Sleep deprivation. You will have 2 weeks during which you will be in survival mode, eating bites of food when you can and falling asleep upon walking in your front door when you get home. It’s expected and it’s no fun, but you will get through it! After this rotation I’ve repeated to my classmates and they agree that it is true, “anything is survivable for 2 weeks!”
- I wish we had done more topic rounds. Neuro gets busy and time gets away from you, so it’s understandable, but it still would have been nice.
- Caseload is often unmanageable for students. It’s hard to have 5+ inpatients and then be seeing more cases every day and being on call for emergencies at night. While I was on the service it was just students responsible for treatments during the day and techs could help if needed. Fortunately the school realized how much of a burden that was on us and hired underclassmen to come in as a treatment crew to assist the neuro and medicine students with their treatments. That has been a life-saver!
- My most rewarding moment on neuro was a dog that was rather suddenly unable to walk and the owner was a blind man. The dog and its owner were incredibly bonded and the dog meant everything to the owner. We were able to perform surgery to fix the problem in the dog’s back and I was astonished to see how quickly the dog rebounded and was standing and walking in no time! Reuniting the dog with it’s owner was a tearful occasion that the owner’s friend videotaped. I have never seen an animal or it’s owner more elated to be reunited! I will surely cherish that memory forever!