can any resident tell sth about his/her first few months life in wards or oncall

[yue1220]

what's life fo the first few months like? do you guys have to do lumber puncture by yourself?

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[yue1220]

and when does your first oncall start?

 

[typhoonegator]

I was on-call my first day (hey, someone has to be!)

The learning curve was steep for my program, but there are others where you get eased-in a bit more, with more didactics and senior support for the first few weeks. Either way, the only way to get proficient (and therefore comfortable) is to just do it, and you'll be up to speed by September.

I've never done a lumber puncture

A senior watched me do my first lumbar puncture, but after that I was on my own, unless I needed someone to hold the patient down.

 

[bustbones26]

what's life fo the first few months like? do you guys have to do lumber puncture by yourself?

Call as an intern or call as a PGY-2 Neurology resident?

For the first few months of PGY-2 Neurology resident, here is about how it worked at my hospital. There is a consult resident that is a PGY-3 or above, they are carrying a pager and taking calls from the ED and inpatient services all day. Whenever they get a call for a consult, how they handle it depends really on who that person is, for example, they might have you see the consult for them as a learning experience, just do it themself, do it together, etc. etc. no definite pattern. But we do have admitting privileges so if the consult resident does admit a patient out of the ED to the Neurology inpatient service, that patient now becomes your primary responsibility. The bulk of inpatient admission to the neurology ward are stroke work ups, stroke work ups, stroke work ups, and stroke work ups. Other admission included intractible headache, altered mental status, brain mass, etc.

Consults primarily come from the ICU and at our hospital the bulk of these consults are: altered mental status, not waking up because of x,y,z, status epilepticus/could this be a seizure??, and lately critical illness myopathy has become a big hit. More rare consults are the person that was in the hospital for something else and had a stroke while inpatient or just neurological question from an inpatient service, e.g. we are changing so and so's medications for his heart failure, how will this affect his PD meds, etc. Again, there is a more senior consult resident taking these calls but you are expected to help out if not busy or if it is their preference for you to do so.

So when a person is admitted to the Neurology Ward service, it is your responsibility to round on that person and take care of them everyday (or ensure that the intern/medical student is doing it adequately and follow along closely). As far as things like LPs?? At my hospital, the unofficial official policy is that once you have done 5 supervised LPs, you can do them on your own. And any other procedures for that matter followed the same kind of rule.

Call of course differs from program to program, at my program, call hours were 4PM - 7AM. While on call, you essentially were admitting patients from the ED.

Rounds depend on who your attending is. As you very well know, Surgery can round on 30 patients in 90 minutes or less and Neurology could round on 5 patients all day!! That is just how neurologist are.