Neuro SubI - What to Bring?

[medsRus]

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I will shortly be in a neurology subinternship, what do I really need to bring with me? I really want to be fully equip and appear a serious candidate. Thank you.

 

[typhoonegator]

1. A big smile
2. An eager and positive attitude (but not too eager)
3. A willingness to arrive early and stay late
4. An understanding that no scut is beneath you
5. A neuro-bag, containing:

a. flashlight​

b. Snellen chart​

c. a good reflex hammer​

d. tuning forks​

e. safety pins​

f. measuring tape (if doing pedi)​

g. colored blocks (if doing pedi)​

h. ophthalmoscope​

i. red glass​

The sub-interns that impressed me the most were not the ones who talked the most, worked the fastest, or knew the most pimpage. The really good ones anticipated problems and planned for them, and were able to differentiate important from unimportant. No one expects you to know everything, but if you anticipate your senior resident's concerns, you'll look like a star. I'll never forget the time on ICU rounds when the sub-I cheerfully reported that Mr. Jones had excellent blood sugar control overnight, only to have the nurse tap me on the shoulder and mention that he had new ocular bobbing this morning. You don't want that to happen.

 

[medsRus]

1. A big smile
2. An eager and positive attitude (but not too eager)
3. A willingness to arrive early and stay late
4. An understanding that no scut is beneath you
5. A neuro-bag, containing:

a. flashlight​

b. Snellen chart​

c. a good reflex hammer​

d. tuning forks​

e. safety pins​

f. measuring tape (if doing pedi)​

g. colored blocks (if doing pedi)​

h. ophthalmoscope​

i. red glass​

The sub-interns that impressed me the most were not the ones who talked the most, worked the fastest, or knew the most pimpage. The really good ones anticipated problems and planned for them, and were able to differentiate important from unimportant. No one expects you to know everything, but if you anticipate your senior resident's concerns, you'll look like a star. I'll never forget the time on ICU rounds when the sub-I cheerfully reported that Mr. Jones had excellent blood sugar control overnight, only to have the nurse tap me on the shoulder and mention that he had new ocular bobbing this morning. You don't want that to happen.

This is great information. Do you have recommendations for which ophthalmoscope to buy on a limited budget? Also, there are a bunch of combined tools available. Are they any good? Thank you.

 

[typhoonegator]

I would steer clear of combined tools, as they often end up doing nothing well. Keep it simple with a good reflex hammer (Troemner, Babinski, or Queen's Square) and a cheap tuning fork.

Picking an ophthalmoscope is a personal choice. I hate the Pan-optic. It costs way more than it should, it is enormous, heavy, and scary to patients. I use those little cheezy pen-scope ophthalmoscopes -- they're cheap, tiny, and good enough for emergency room work, when all you really need to see is the disk and venous pulsations. When it breaks or you lose it, it isn't the end of the world, just get another one. It certainly isn't good enough for a full eye exam, but it's fine for guerilla neurology.

Things that I forgot in my last post:

NINDS stroke cards. You can also just get them off the internet and print them off, rather than getting the fancy laminated ones, if you want.​

OKN strip. You can make it yourself or buy one, but it definitely comes in handy at times. You might not need it for a sub-I, but you will someday anyway.​

 

[bustbones26]

I will shortly be in a neurology subinternship, what do I really need to bring with me? I really want to be fully equip and appear a serious candidate. Thank you.

1) A pocket protector for your white coat
2) A piece of masking tape to place in the middle of your glasses
3) The largest hammer you can find. In fact, just go down to the local hardware store and pick up the largest ball pien hammer you can find
4) A portable spot light for pupil exams
5) A Darth Vader action figure, er, maybe Star Trek to hang off your neuro tool kit.

Now, if you want to be taken serious:

1) Talk about Sci Fi TV shows constantly
2) Never speak anything that has less than six syllables. In fact, if you diagnose a person with a condition, find the longest most elaborate word possible to call it
3) Before every sentence say, "clearly" a lot, with intonation

Okay, I hope you enjoyed my sarcasm just little. Though it might entertain you a bit.

On another note, just show up and look genuinely interested. That helps more than anything.

 

[medsRus]

Do you guys use a pinwheel for pain sensation?

 

[PhakeDoc]

Do you guys use a pinwheel for pain sensation?

large safety pins. One per patient, i.e. do not reuse. That's why you should stay away from pinwheels.

 

[NamasteSiempre]

OMG bustbones26 that was hilarious. you had me rolling. but seriously do we need to buy an ophthalmoscope before doing an away sub-i? they are so expensive! if you know of a cheap one, can you mention the brand and model #? and also the red glass and OKN strip? I didn't use that during my clerkship. i can make an OKN strip at home. do you know the dimensions of it and how far apart each stripe is? thanks!

 

[typhoonegator]

You never really know when you are going to need some of this stuff. I find the red glass helpful, but if you don't know how to use it, you might as well not get one.

The distance between bars doesn't matter too much on an OKN strip. I used to have one for pedi that was a string of stupid-looking turtles, so there you go. My usual one has black stripes alternating with white, about 1.5cm across. Bonus points if you macrame one and glue some rhinestones to it.

Regarding an ophthalmoscope, you be the judge. I use a Riester Pen-scope, because it is small and cheap, and therefore I never had an excuse not to have it on me during residency. The view kind of sucks, but it is convenient, and once you get good with it, you can see just about everything you need to see. Truth be told, I didn't have an ophthalmoscope until I finished internship. I clearly recall during my clerkship 6 (!) years ago when my attending asked for my ophthalmoscope during rounds, and I said, "I don't have one, I'm poor and I chose food instead." Everyone laughed (including the patient) and I was never bothered about it again.

 

[JaSam]

1) A pocket protector for your white coat
2) A piece of masking tape to place in the middle of your glasses
3) The largest hammer you can find. In fact, just go down to the local hardware store and pick up the largest ball pien hammer you can find
4) A portable spot light for pupil exams
5) A Darth Vader action figure, er, maybe Star Trek to hang off your neuro tool kit.

Now, if you want to be taken serious:

1) Talk about Sci Fi TV shows constantly
2) Never speak anything that has less than six syllables. In fact, if you diagnose a person with a condition, find the longest most elaborate word possible to call it
3) Before every sentence say, "clearly" a lot, with intonation

Okay, I hope you enjoyed my sarcasm just little. Though it might entertain you a bit.

On another note, just show up and look genuinely interested. That helps more than anything.

lol, nice one. Actually I'd like to add one very important item to the list.......
YOUR Letter of Recommendation forms and cover letter. That's actually all you really need for your neuro month. Cuz honestly who are we kidding. That's all your after anyway.

Stop beating around the bush.

 

[Vader]

The sub-interns that impressed me the most were not the ones who talked the most, worked the fastest, or knew the most pimpage. The really good ones anticipated problems and planned for them, and were able to differentiate important from unimportant. No one expects you to know everything, but if you anticipate your senior resident's concerns, you'll look like a star. I'll never forget the time on ICU rounds when the sub-I cheerfully reported that Mr. Jones had excellent blood sugar control overnight, only to have the nurse tap me on the shoulder and mention that he had new ocular bobbing this morning. You don't want that to happen.

To be fair, the nurses know who "the med student" and "the resident" is and often will not give the med student the vital info from overnight and instead wait to give it to the resident. This is just something to accept as part of being "the med student" on the team. Most residents realize this and do not frown on med students for not knowing something like that on rounds. Residents WILL frown on lying about information--always better to answer "I don't know--I'll look it up" than to make stuff up.

 

[pep45]

You don't have to bring a 39 dollar reflex hammer and an opthalmoscope to impress anyone--Most residents don't buy an opthalmoscope 'til second year anyways. If you show up eager to learn about neurology, have a good attitude, and are able to perform and present a basic neurological examination in a systematic way the same way every time you will impress your attendings. Be sure to present and describe your findings on exam in a meaningful way; Cranial Nerves II-XII are grossly intact is OK if you want to be an ER physician, but as a neurologist you need to show that you tested and understand the function of the test you performed. (Fundi appear normal with sharp optic disc margins, Visual Fields are full, EOMI, PERRLA, etc...) Write good progress notes--this impresses the residents and lessens the load of what they have to do. They don't expect you to be able to perform like a second year resident, and honestly if you show up with a leather bag full of diagnostic tools that you have no clue how to use properly, you are probably going to look like a tool yourself. Just my opinion but I feel that I have had a great experience on my Sub-I and it's been mostly because I have worked hard and demonstrated competence. If you can't fit it in your pockets then you don't really need it yet. That being said, have a decent hammer (mine was 8 dollars on ebay), tuning fork, some type of neuro handbook, safety pins or tooth picks are sufficient for pinprick, and a penlight and you will be prepared! Best of Luck and just keep on smiling even if you have worked 14 straight 12+ hour days!!

 

[bbake87]

1) A pocket protector for your white coat
2) A piece of masking tape to place in the middle of your glasses
3) The largest hammer you can find. In fact, just go down to the local hardware store and pick up the largest ball pien hammer you can find
4) A portable spot light for pupil exams
5) A Darth Vader action figure, er, maybe Star Trek to hang off your neuro tool kit.

Now, if you want to be taken serious:

1) Talk about Sci Fi TV shows constantly
2) Never speak anything that has less than six syllables. In fact, if you diagnose a person with a condition, find the longest most elaborate word possible to call it
3) Before every sentence say, "clearly" a lot, with intonation

Okay, I hope you enjoyed my sarcasm just little. Though it might entertain you a bit.

On another note, just show up and look genuinely interested. That helps more than anything.

Clearly, well said Bustbones!