residency issues... can anyone help?

[drCNS]

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Couple of questions:
- I've heard that some programs staff their overnight consults with residents and not attendings. How common is this practice? Do you guys staff consults with attendings overnight?
- I've also heard that other programs are becoming heavier and heavier in terms of neurocritical care rotations, but that there are no requirements for this. How much time is required to spend in neurocritical care units at different programs?
Thanks!

 

[Raggaman]

Couple of questions:
- I've heard that some programs staff their overnight consults with residents and not attendings. How common is this practice? Do you guys staff consults with attendings overnight?
- I've also heard that other programs are becoming heavier and heavier in terms of neurocritical care rotations, but that there are no requirements for this. How much time is required to spend in neurocritical care units at different programs?
Thanks!

All consults are done by residents. Overnight or not. Depending on the urgency and/or difficulty of the consult, level of resident (PGY2 vs PGY4) and laziness of attending, consults maybe seen at night, but most are seen the next day.

 

[Iliopsoas]

At my institution, we staff overnight consults with senior residents. It was a strange concept at first because you really have to trust your senior to help you make the right decision. After several months, I think it's actually one of the strengths of our residency program. Eventually an attending hears about all the patients, but I think it's great to think through all the problems and come up with your own plan. While I can think of strengths of both methods, I am happy with ours. Having said that, there are certain scenarios you have to talk to attendings about; i.e. tPA.

Regarding NCC, I do feel like a lot more programs are exposing residents to this field. Part of it has to do with academic institutions attracting sicker patients by and large and thereby attracting NCC attendings. While there are opportunities to work in NCC in the non-academic sector, there seems to already by good infrastructure for having NCC at academic centers. I think this partially explains the widespread exposure to NCC. I for one am very happy about this, but I can see how my counterparts who want to study electrophys are not to psyched about it.

 

[drCNS]

So I actually spoke to some buddies in other programs and found out that actually, the majority of programs also have senior residents staffing overnight consults! I found this surprising.
In terms of NCC, it seems like they are trying to make us cover the unit more and more, and most residents who will not go into that field, don't want to do that, as they will have to sacrifice elective time to do so. We already have a block of NCC as PGY2s, and now they're trying to add another block as PGY3s and 4s...

 

[typhoonegator]

Medicine residents have to cover the MICU and CCU even though most of them will not become intensivists. Surgical and anesthesia residents have to staff the SICU even though most of them will not do Trauma/SICU.

You are a neurology resident. Your job is to take care of neurology patients. Just because they happen to be critically ill doesn't make them any less your responsibility. Neurocritical care has increased the stature, visibility, and solvency of many academic neurology departments, and has changed opinions about neurology as an acute care specialty. To cede that responsibility to others would diminish neurology as a field.

Somehow geriatricians made it through their MICU rotations, as did infectious disease doctors, endocrinologists, PCPs, sleep specialists, and pain docs. I like to think those experiences made them better physicians in their chosen specialty.

 

[danielmd06]

Medicine residents have to cover the MICU and CCU even though most of them will not become intensivists. Surgical and anesthesia residents have to staff the SICU even though most of them will not do Trauma/SICU.

You are a neurology resident. Your job is to take care of neurology patients. Just because they happen to be critically ill doesn't make them any less your responsibility. Neurocritical care has increased the stature, visibility, and solvency of many academic neurology departments, and has changed opinions about neurology as an acute care specialty. To cede that responsibility to others would diminish neurology as a field.

Somehow geriatricians made it through their MICU rotations, as did infectious disease doctors, endocrinologists, PCPs, sleep specialists, and pain docs. I like to think those experiences made them better physicians in their chosen specialty.

Not everything you do in high school, college, medical school, or residency has a direct impact on your final career pathway and yet it's funny how individuals choose to gripe about certain difficult aspects of these times in all the years of training they accomplish. Neurosurgical care and neurocritical care only make you stronger, smarter, and better.

I personally hated pediatric neurology and neuromuscular rotations with a passion...but they helped me to learn as a resident. I believe typoonegator is correct to urge you to view the greater scope of our field (and your own career) and act accordingly.

 

[michaelrack]

xx

 

[BlackFrancis33]

I agree broad exposure is important. Still residency already overemphasizes the inpatient arena. Serving in NCC is important but shouldn't come at the expense of gaining outpatient, electrophys exposure etc. I forsee residents serving as the labor force and losing even more outpatient exposure if a program places too much emphasis on NCC.