Introduction
One of the primary clinical responsibilities of a practicing neurologist is to serve as a consultant for patients with a variety of neurological problems in the hospital setting. Consults may be requested for primary neurological diseases, neurological complications of systemic diseases, or the neurological complications associated with medical and surgical therapies.
This rotation is for PGY-3 and PGY-4 residents, who have already developed considerable neurological skills while rotating on our own inpatient services and are now ready for more independence.
The inpatient consult team is led by a senior neurology resident and also includes attending neurologists for the stroke and general neurology services, a nurse practitioner or physician’s assistant, and medical students. Occasionally there are neurosurgery interns, radiology interns, or internal medicine residents pursuing elective rotations.
Goals
Residents will learn to serve as consultants for the spectrum of neurological problems, especially altered mental status, common complications of medical procedures, and common complications of anesthesia and surgery. They will develop the professional and interpersonal skills needed to consult on such patients for a variety of requesting physicians and surgeons and work as part of an interdisciplinary team.
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
| Rotation Objectives | ||
| Upon completion of the curriculum, residents will . . . | ||
| # | Description | Milestones |
| 1 | Evaluate and manage seizures and status epilepticus | PC1, PC2, PC3, PC5, PC6, PC9, PC12, MK1, MK2 |
| 2 | Evaluate and manage acute neuromuscular conditions such as Guillain-Barré syndrome and myasthenia gravis | PC1, PC2, PC3, PC5, PC6, PC10, MK1, MK2 |
| 3 | Evaluate and manage patients with acutely altered consciousness, cognition, and behavior | PC1, PC2, PC3, PC5, PC6, PC8, PC9, PC12, MK1, MK2 |
| 4 | Evaluate and manage patients with MS relapse and other acute demyelinating disorders | PC1, PC2, PC3, PC5, PC8, PC12, MK1, MK2 |
| 5 | Evaluate and manage patients with acute or intractable headache | PC1, PC2, PC3, PC5, PC6, PC8, MK1, MK2 |
| 6 | Appropriately select and interpret neuroimaging studies | PC8 |
| 7 | Communicate effectively with requesting teams | SP3, SP4, PR1, IC3, IC4 |
| 8 | Lead family meetings regarding goals of care and negotiate conflicts among family members and the treatment team | SP4, PR1, IC1, IC2 |
| Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| PC7, PC11, PL1, PL2, PR2, PR3 | ||
Schedule
The resident will be in charge of the Consult Service to see new inpatient consults for stroke and general neurology and allocate responsibility for follow-up of existing consult patients. They will cover the neurology consult pager each weekday from 8:00 am to 4:00 am. Attending teaching rounds with general and stroke attendings will occur daily at a mutually agreed upon time, often starting around 1:00 pm. At 4:00 pm, the night float resident will become first call on the pager. The Consult resident will then finish seeing and staffing any consults that were received before 4:00 pm and give formal sign-out on active consult patients (if any) to the night float resident.
The Consult service resident is expected to attend regularly scheduled educational lectures at 12:00 pm (Monday – Friday) and 8:00 am morning report (Friday) unless addressing urgent or emergent clinical issues for service patients. Resident are also expected to attend Neuropathology conferences on Wednesday mornings at 8:30 am (on the 1st, 3rd, and 5th Wednesdays of the month) and Neuroradiology conference on Wednesday morning at 7:30 am (on the 4th Wednesday of the month).
Work Hours
There are no additional call responsibilities beyond the normal neurology call schedule during this rotation. The total hours per week is expected to be 60. Residents will adhere to all work hours restrictions required by ACGME and will log work hours electronically. The resident is expected to notify the staff attending and the program director if he or she is jeopardy of violating work hour restrictions.
Suggested References
Josephson, S. A., & Aminoff, M. J. (Michael J. (2014). Aminoff’s neurology and general medicine.
Josephson, S. A., Freeman, W. D., & Likosky, D. J. (2011). Neurohospitalist medicine. Cambridge: Cambridge University Press.
Plum 1924-2010, F., Herman Rubinstein, M. M., Posner 1932-, J. B., & Rubinstein, L. J. (Lucien J. (2007). Plum and Posner’s diagnosis of stupor and coma. Oxford ; New York: Oxford University Press.
Latest revision: 05-14-2021
