First Rotation, advice

[soccer1693]

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Hello all! Just got assigned my first rotation! I'm doing Neurology first, which is 4 weeks (2 inpatient, 2 outpatient). Our school has accelerated pre-clinicals, so we just took step 1 this winter (awaiting results currently).
Was wondering if anyone has any advice for starting rotations, and specifically about the neurology rotation? Any books, apps, etc, that you loved?
Thanks for any/all advice--general or specific!

 

[Anti-PD1]

Pre-Test Neurology is a good review book.

Know your stroke syndromes well, not just text-book brainstem stuff that rarely occurs, but obvious distinctions, like cortical vs deep, etiologies and their locations. Atherosclerosis, hypertension, amyloid angiopathy, how they each present. Learn the NIHSS and GCS. Stroke science is evolving, it's not just tPA anymore, learn about IA, and the recent trials extending the therapeutic window, i.e. DAWN, MR CLEAN (no joke dude). Commit to memory your basic post stroke work up, i.e. carotid U/S, TTE, lipids, HbA1C, LFTs, PT/PTT, CBC etc.

Be proficient at the neuro exam. Every neurologist has his/her own bag of tricks and style. Just know what you're testing for. Pick up on things that annoy people when you're presenting and try to shed yourself of them. I.e. it's basically impossible to lose light touch sensation, unless you get a complete spinal cord injury, tell them about vibration, proprioception, pain. Also, if you're consulting for a localized spine problem, probably not best to start off with, 'PERRLA, EOMI' BS. Common sense stuff.

Neurology is anatomy. Know your anatomy well. Neuroanatomy is love. Also, expect a lotttt of bow ties... and bow tie personalities.

 

[You shall know the Truth]

Pre-Test Neurology is a good review book.

Know your stroke syndromes well, not just text-book brainstem stuff that rarely occurs, but obvious distinctions, like cortical vs deep, etiologies and their locations. Atherosclerosis, hypertension, amyloid angiopathy, how they each present. Learn the NIHSS and GCS. Stroke science is evolving, it's not just tPA anymore, learn about IA, and the recent trials extending the therapeutic window, i.e. DAWN, MR CLEAN (no joke dude). Commit to memory your basic post stroke work up, i.e. carotid U/S, TTE, lipids, HbA1C, LFTs, PT/PTT, CBC etc.

Be proficient at the neuro exam. Every neurologist has his/her own bag of tricks and style. Just know what you're testing for. Pick up on things that annoy people when you're presenting and try to shed yourself of them. I.e. it's basically impossible to lose light touch sensation, unless you get a complete spinal cord injury, tell them about vibration, proprioception, pain. Also, if you're consulting for a localized spine problem, probably not best to start off with, 'PERRLA, EOMI' BS. Common sense stuff.

Neurology is anatomy. Know your anatomy well. Neuroanatomy is love. Also, expect a lotttt of bow ties... and bow tie personalities.

What is a bow tie personality?

 

[frosted2]

Pre-Test Neurology is a good review book.

Know your stroke syndromes well, not just text-book brainstem stuff that rarely occurs, but obvious distinctions, like cortical vs deep, etiologies and their locations. Atherosclerosis, hypertension, amyloid angiopathy, how they each present. Learn the NIHSS and GCS. Stroke science is evolving, it's not just tPA anymore, learn about IA, and the recent trials extending the therapeutic window, i.e. DAWN, MR CLEAN (no joke dude). Commit to memory your basic post stroke work up, i.e. carotid U/S, TTE, lipids, HbA1C, LFTs, PT/PTT, CBC etc.

Be proficient at the neuro exam. Every neurologist has his/her own bag of tricks and style. Just know what you're testing for. Pick up on things that annoy people when you're presenting and try to shed yourself of them. I.e. it's basically impossible to lose light touch sensation, unless you get a complete spinal cord injury, tell them about vibration, proprioception, pain. Also, if you're consulting for a localized spine problem, probably not best to start off with, 'PERRLA, EOMI' BS. Common sense stuff.

Neurology is anatomy. Know your anatomy well. Neuroanatomy is love. Also, expect a lotttt of bow ties... and bow tie personalities.

Bookmarking this for future use. Thanks!!!

 

[Anti-PD1]

Bookmarking this for future use. Thanks!!!

From the American Academy of Neurology. Neurologists are a precise people.

 

[soccer1693]

Pre-Test Neurology is a good review book.

Know your stroke syndromes well, not just text-book brainstem stuff that rarely occurs, but obvious distinctions, like cortical vs deep, etiologies and their locations. Atherosclerosis, hypertension, amyloid angiopathy, how they each present. Learn the NIHSS and GCS. Stroke science is evolving, it's not just tPA anymore, learn about IA, and the recent trials extending the therapeutic window, i.e. DAWN, MR CLEAN (no joke dude). Commit to memory your basic post stroke work up, i.e. carotid U/S, TTE, lipids, HbA1C, LFTs, PT/PTT, CBC etc.

Be proficient at the neuro exam. Every neurologist has his/her own bag of tricks and style. Just know what you're testing for. Pick up on things that annoy people when you're presenting and try to shed yourself of them. I.e. it's basically impossible to lose light touch sensation, unless you get a complete spinal cord injury, tell them about vibration, proprioception, pain. Also, if you're consulting for a localized spine problem, probably not best to start off with, 'PERRLA, EOMI' BS. Common sense stuff.

Neurology is anatomy. Know your anatomy well. Neuroanatomy is love. Also, expect a lotttt of bow ties... and bow tie personalities.

Thank you so much! This is incredibly helpful!!

 

[CherryRedDracul]

Look up the Rule of 4 for the brainstem.

The rule of 4 of the brainstem

I still use it to this day to hone in on specific neuro territories when I read CT or MR brains for stroke symptoms.

 

[DBV]

Learn early how to realize it's the wrong time to ask a question and become aware of how little you tangibly help and how in the way you are.

 

[CherryRedDracul]

Learn early how to realize it's the wrong time to ask a question and become aware of how little you tangibly help and how in the way you are.

On the flipside, figure out where you are actually helpful. As useless as medical students might feel, there are moments when their attention to detail is invaluable. So learn how to take a good history. You'll naturally ask too many irrelevant things early on, but you'll learn how to hone down your history as you become more experienced.

When I was a med student, my actions did significant alter my patients' management for the better. Not always, but I had my moments.

 

[DBV]

On the flipside, figure out where you are actually helpful. As useless as medical students might feel, there are moments when their attention to detail is invaluable. So learn how to take a good history. You'll naturally ask too many irrelevant things early on, but you'll learn how to hone down your history as you become more experienced.

When I was a med student, my actions did significant alter my patients' management for the better. Not always, but I had my moments.

Few and fleeting I'd imagine

 

[CherryRedDracul]

Few and fleeting I'd imagine

Definitely few. The med student is the lowest on the totem pool and has the smallest fund of knowledge, so the significant things that they do catch onto have often been realized by the residents, fellows, and attendings. Fleeting? I disagree. Those bright moments, just like the lowest moments, stick with you.

 

[Anti-PD1]

On the flipside, figure out where you are actually helpful. As useless as medical students might feel, there are moments when their attention to detail is invaluable. So learn how to take a good history. You'll naturally ask too many irrelevant things early on, but you'll learn how to hone down your history as you become more experienced.

When I was a med student, my actions did significant alter my patients' management for the better. Not always, but I had my moments.

Agree. Things that help, i.e. for stroke, be a hawk when asking about current medications. Any anticoagulants are vital to know. Patients don't remember the names. Eliquis vs Xarelto vs Warfarin. If there's any question, one thing you can do with that med student time is track down the PCP, and have their last appointment chart faxed. Hand that to the resident like a G. Profit.

Also, offer to make those PCP follow-up appointment calls for patients being dc'ed. Get a list, bang it out. Help with flow. When things flow, people are happy, patients are healthy.

 

[Menander's Bust]

Study from day -2 or sooner. Really overkill the studying this rotation. Once you get a feel for how you do you can dial it back in later rotations. You hear so many stories of people who hit week 3 of 4 or 5 of 6 of their rotation and haven’t studied that much but don’t realize that clinic doesn't really prepare you for the shelf (you should assume that 80% of what you see in clinic is the most common stuff and that this will account for 20-35% only of your shelf exam questions).

It’s tough to get used to working all day in clinic then studying at night and some people are slow to figure this out. So go hard studying early and you’ll be fine. But study at home and on the weekend. Studying at clinic is sometimes possible but in my experience rarely successful, and then you become that clueless student who’s always reading and disengaged. This never goes over well. If you feel you must do this, don’t the first 1-2 weeks so it’s not the first impression they get of you. And stay off your phone. People assume you’re on Facebook even though people don’t really use Facebook that much anymore.