If neuro training doesn’t start till PGY2, what exactly can I expect for a neuro SUBI rotation in M4?

[deleted1139416]

I understand that SUB-I means functioning at the level of an intern. But neuro training doesn’t start till PGY2, so what exactly is expected of M4 students in neuro SUB-Is? Obviously they can’t expect them to function at the level of PGY-2s.

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[DrStephenStrange]

I understand that SUB-I means functioning at the level of an intern. But neuro training doesn’t start till PGY2, so what exactly is expected of M4 students in neuro SUB-Is? Obviously they can’t expect them to function at the level of PGY-2s.

Most likely working directly in Neurology with PGY-2s or above. At least that's how my SubIs were. Also, it depends on the program. Some programs have more integrated Neuro blocks in first year than others, so you may be working with PGY-1s as well.

Edit: They do not expect you to be able to perform at the level of a PGY-2 resident, but at least be able to take a good history, present well, do a good and full Neuro exam, explain exam findings, be part of the team, show enthusiasm, and get well with others.

 

[deleted1139416]

Most likely working directly in Neurology with PGY-2s or above. At least that's how my SubIs were. Also, it depends on the program. Some programs have more integrated Neuro blocks in first year than others, so you may be working with PGY-1s as well.

Edit: They do not expect you to be able to perform at the level of a PGY-2 resident, but at least be able to take a good history, present well, do a good and full Neuro exam, explain exam findings, be part of the team, show enthusiasm, and get well with others.

Thanks man! But I thought ACGME had a rule that the first year needs to be strictly IM and residents are not allowed to be on the service of their specialty for more than a month?

 

[DrStephenStrange]

Thanks man! But I thought ACGME had a rule that the first year needs to be strictly IM and residents are not allowed to be on the service of their specialty for more than a month?

That's not true!
I have attached the ACGME requirements for neuro intern year curriculum. You can do up to 4 months in Neurology. 8 months of IM or 6 months of IM and 2 months in either EM, FM, IM or Peds. The IM months can also be in subspecialties like Cards, Nephro, GI, etc...

My program is categorical. I have 4 Neuro inpatient blocks, and I actually only do 2 months in actual IM inpatient. My other blocks are Cards, Nephro, ICU, psych, FM, and sleep medicine.

 

[xenotype]

We don't expect Sub I/AI to operate at the level of a neurology intern. Most programs are categorical so there are neurology interns on service periodically in some programs. I'd expect a sub I to round on about 4 patients a day, knowing their histories well for the attending and having some idea of what the plan and disposition is. Intern would be double that number. I'd expect sub I to see 'stable' patients in the ED like headaches, MS exab, routine inpatient consults and present a plan and exam but would not expect them to know special exam maneuvers or necessarily get the plan correct. Would not expect them to be able to independently examine intubated patients for example, but I would expect interns to start knowing this. Either sub I or intern I would have first attempt at an LP with junior/senior resident taking over if the needle pass isn't successful.

Don't be afraid on sub I on neuro. If you show up on time/early, are enthusiastic, at least somewhat organized in presentations you could probably get away with not even know how to do a basic neuro exam. That can always be taught later. Sub Is are generally going to help for somewhere you want to match, and are only going to harm if you show up late, are offensive/unprofessional/lie about something, seem more clueless than a beginning third year student/can't present a patient with any semblance of order. A really good sub I will get you ranked to match at a lot of programs.

 

[Captain_Falcon]

How many patients should a 4th year be seeing daily by the end of a neuro ICU rotation?

 

[Asklepian]

How many patients should a 4th year be seeing daily by the end of a neuro ICU rotation?

I wouldn't stress too much about it. Do a bang-up job with the patient(s) you do have, and if they give you more put your all into that, too. Quality > quantity IMO

 

[Aldertonghen]

Thanks man! But I thought ACGME had a rule that the first year needs to be strictly IM and residents are not allowed to be on the service of their specialty for more than a month?

Not really. My program for example has 4 blocks of neuro (2 in stroke alone)+ a block of bootcamp , and so by the end of PGY1 most of us do have a decent idea of how to run a stroke code (with variable levels of senior assistance- depends on the intern). This is in addition to half day neurology continuity clinics, and another half day neurology conference, which keep going on during our medicine rotations. We also get to scrub in for endovascular if we’re super interested in interventions.

The expectation of either a sub I or an intern is to show up early and be enthusiastic, and ready to work hard until 5pm (atleast until one becomes efficient). A basic 5 min neuro exam is sufficient, I’m still learning the more nuanced stuff. Our cap is at 8 patients (usually 6-7) for an intern, and usually 3/4 for a subI. The difference is a subI will always have a resident with them always at my program, but an intern might not have (eg: if senior has continuity clinic in the afternoon).

 

[Captain_Falcon]

I wouldn't stress too much about it. Do a bang-up job with the patient(s) you do have, and if they give you more put your all into that, too. Quality > quantity IMO

I was told to take 2 max initially by a resident so I'm guessing I'll just do that. There are 3 residents/fellows on service each day in addition to the APPs for a unit that has about 12 pts on average. So I guess 2 is realistic and sufficient? On my neuro sub-I I carried up to 6, typically had 3-4 on most days

 

[deleted1139416]

On my neuro sub-I I carried up to 6, typically had 3-4 on most days

This scares the crap out of me. I can barely handle 2-3 patients on my IM rotation! Although I did just start 3rd year like 2 weeks ago LOL

 

[Captain_Falcon]

This scares the crap out of me. I can barely handle 2-3 patients on my IM rotation! Although I did just start 3rd year like 2 weeks ago LOL

In a year youll be much more efficient. Also on IM you're handling lots of problems; on neuro you'll likely be focusing on the 1 or 2 neurological complaints

 

[deleted1139416]

In a year youll be much more efficient. Also on IM you're handling lots of problems; on neuro you'll likely be focusing on the 1 or 2 neurological complaints

Thanks man! This kind of encouragement is really great!

 

[NEApplicant]

How many patients should a 4th year be seeing daily by the end of a neuro ICU rotation?

When I did my sub-I in neuro ICU, I started off with 1-2, finished up with 3-4 usually. I don't think I ever carried more than 4. Then I'd listen in on the other presentations and ask questions about things I found interesting.