Neurology Rotation - need advice

[oksusu]

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Hello SDN,

I will be starting my 3rd year clerkships with inpatient neurology. I am very confused as what I do as a 3rd year; my understanding is there is a preround and a round.

What is done in the pre-round and rounds? Can someone go through what they did during their neurology clerkships?

During pre-round, do I take chief complaint, H&P - what would consist of a focused physical? I would think I would need to complete CN assesment, mental status: , reflexes, dermatomes, quickly listen to the heart, lungs at the minimum. I would estimate this is going to take me at least 30 minutes, since I don't know anything at all. Are the patient's even responsive at 6am in the morning and would they get annoyed by my slow pace?

I don't know what the hell I'm suppose to do and feel like I'm just going to be thrown into the pits of fire. Heck I don't even know how to navigate the electronic health records yet....

Any advice will be appreciated.

 

[Mountaineer12]

The residents should help you because they'll know it's your first rotation. For pre-rounds you basically just see how the patient did overnight and ask them pertinent questions (subjective) and do a very focused exam (objective). You also review any notes about them overnight (subjective) and look at vitals + labs + imaging + med changes (all objective) in the chart. You then develop an assessment/plan based on all of that. Residents and past progress notes will help a lot with A/P for the first few rotations.

This may seem like a lot and it may take you awhile at first, but eventually it should take <10-15 minutes per patient. At first though, don't feel bad if it takes over half an hour per patient. They know you're new to this! Once you gather all the info, you'll present it in SOAP note form on rounds with the residents and attending.

I hope that helps!

Oh, and a good place to start your first day with your first patient is their H&P then skim the A/P in each day's process note to get an idea of what's going on with them.


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[KinesiologyNerd]

The bar for your first rotation will be a millimeter off the floor. Just listen to what your residents tell you and go from there. It comes quickly. (and don't test dermatomes)