Day in the life of a neurology resident

In this brief article we are going to answer the question ‘’Day in the life of a neurology resident’’ We will detail the activities of each year of the neurology residents, their schedule and their biggest challenges.

Day in the life of a neurology resident

Your day will start at 7:00 with the morning report and lectures and will end around 5:00. During that time, you will be in charge of the consultations and supervision of the consultation team depending on the year of residency in which you are.

A residency results from the need and interest of a general practitioner to expand his professional development with knowledge, skills and values ​​about a medical specialty, so that he can deepen his knowledge.

The resident decides which specialty he is going to do, therefore renounces the practice of general medicine and commits himself to the chosen specialty developing the learning of knowledge, skills and values ​​of the specialty in the institution that he considers most appropriate for his professional development and where it can also be of greater use to patients and society.

The resident has the option of choosing the specialty that interests him and therefore assumes the way of working of each institution, having to recognize the obligations and duties towards the university to which each course is incorporated and also to comply with the regulations and culture of the host institution;

You must also accept and participate in an excellent interrelation with teachers, colleagues, residents of the different years of each residence and also establish adequate communication with the health personnel where the program is taking place, implying in all this process maturity in all senses of part of the resident, manifesting by behavior according to a medical professional.

Neurology residency

The residency lasts 4 years. The first year is dedicated to Internal Medicine and is called the preliminary year. The next 3 years are in Neurology. T

he structure of the residence depends mainly on the needs of the institution and the number of residents, but there are requirements established by the Accreditation Council for Graduate Medical Education (ACGME) that must be met.

This determines, for example, the minimum time to be allocated to certain rotations, the need for a curriculum with formal teaching sessions, evaluations for residents and treating physicians, limits on working hours, etc.

The resident’s schedule is divided into rotations of 2-4 weeks in length. There are 2 types of rotations: inpatient and outpatient.

Hospital rotations generally consist of a service for patients admitted directly to Neurology and a consultation service. Depending on the number of residents and population to be served, these services can be separate or unified.

Many programs divide inpatients into two different services, one for cerebrovascular diseases and the other for general neurology. Furthermore, certain hospitals have exclusive areas of neurological intensive care and epilepsy monitoring units, in which residents also rotate, expanding their exposure to different pathologies and levels of care.

Rotations

Outpatient rotations include the resident’s own clinic – a requirement of ACGME – and clinics in different subspecialties. The diversity of subspecialties varies from program to program. Some of the most common are Vascular Neurology, Epilepsy, and Movement Disorders.

Other less frequent ones include Neuro-Oncology, Neuro Ophthalmology, NeuroOtology, among others. If the resident has an interest in a subspecialty that is not available at their hospital, many programs offer the option of rotating at other medical centers.

Hospital guards

Hospital guards used to be shifts of 24 hours or more. However, as a consequence of the limits on working hours imposed by ACGME, in the last decade this practice has been replaced by a system of night watches called “night float”.

The resident assigned to this rotation makes new consultations and admissions, and sees patients already admitted during the night. Currently most programs use this system. In addition to limiting continuous work hours, this method offers a more independent experience for residents.

A very valuable aspect of residency is academic activity. Residents are required to make presentations to their peers and / or the entire department. Residents also have the ability to participate in research studies and make publications, either on their own initiative or as collaborators on existing projects. In certain programs, this is a prerequisite for graduation.

Neurology resident

A common day of my residency begins at 8 a.m. with an office until 2 p.m., and then we do a supervised hospitalization room with interconsultated patients from various services, where we make a first evaluation of the patients and subsequent days we follow your evaluation until departure time at 4 pm.

In the first year in a medical clinic you do 10 shifts of 24 hours a month and 8 shifts per month in intensive care, once you pass the second year you do 4 shifts of 24 hours, in addition, Fridays are assigned to hold meetings and to give classes on Interesting cases have arisen in the week, in addition rotations are planned through the area of ophthalmology, Otorhinolaryngology and neuroimaging.

In the third year, almost the same regime is maintained with the possibility of rotation in a hospital in the country or abroad.

First year: A Day in the Life of a PGY2

You get out of bed at around 5:30 a.m., make a sandwich, and get ready for a day of work. You take the hospital, stop by the cafeteria for a glass of coffee, dial the elevator and go to your floor.

Your day starts at 7:00, you must check the report in the morning with the cases that occurred at night. You have a conference with your advisor and your peers, kind of like academic classes.

Now the resident begins to see patients, generally, residents must have interdisciplinary rounds with the social worker, nurses and the case manager, this happens at approximately 10:00, and by noon your rounds on the floor will be finished.

After the rounds, you will have free time to complete the rest of your tasks, all the notes that you must upload to the system. You may be assigned to collect a sample of cerebrospinal fluid in some patients. In addition, you will see the images with your colleagues, the neuroradiologists, who will be very helpful in the team.

When you have consultations, you will be working with a consultation team that is comprised of a first-year resident, a second-year resident, two assistants, and a couple of medical students. The team is likely being led by a senior consultation resident, who will be the one who will assign all of the consultations to you. You should follow up with patients and have new consultations.

Your day closes at 6 pm-7pm and the night float arrives.

If it’s your night float shift, you’ll probably have Fridays and Saturdays off. But, you must attend all the consultations (pediatric and adult) and all the admissions that arrive during the night. You will have the support of a senior resident. Your shift ends at 7:30 am.

Second year: A Day in the Life of a PGY3

Your day will start at 7:30 am. As a senior resident, you will manage the consultation team, which is made up of a first-year resident, a second-year resident, and two assistants. You will have to fill out the morning report and attend a couple of lectures. Your consultation team will attend to the emergency room, admissions and new inpatient consultations. You should assign consultations to the first-year resident and rotators from other specialties.

During the day, you will work with the assistant reviewing the queries from the night before, setting up a follow-up, and making new queries. The volume of consultations depends on the location of the hospital.

Residents find sophomore rotations challenging and busy, but certainly one of the best, as you have more independence and begin to develop your leadership skills.

It is in this second year where you will begin to spend your residency in pediatric neurology, generally, you will have to spend eight weeks of your second year in pediatric neurology. As always, you will complete the morning briefing, conduct rounds on the floor to supervise the pediatric team, and then take responsibility for emergency room inquiries.

Residents gain experience with different procedures and concepts, including ventilator management, management of elevated ICP, management of EVDs, how to perform and interpret TCDs, and continuous vEEG monitoring. 

In the same way you will have rotations in psychiatry and neurocritical attention, usually your work will end at 4:00 – 5:00 pm.

Third year: A Day in the Life of a PGY4

The day of these residents begins at 7:00 with the morning report. Followed by a conference at approximately 9:00 am. Non-stroke admissions will be served by a group consisting of a third year resident, a first year resident, and assistants.

At around 10:00 am the resident will begin rounds on the floor which usually end before noon.

You are a senior resident, you will be in charge of supervising the service and reviewing the images with the neuroradiologists. Your close of shift is at 6:00 pm.

When you are a third year resident you will have so-called “call shifts”. Basically, a couple of days a week after finishing your workday you will stay to support the resident night float until a certain time of the night. When you can retire around 10.00 pm, you will have to be alert to any calls from the June resident in case they need you.

Now, It’s almost 5 o’clock, you saw your last patient, but you still have to finish your notes and make sure everything is resolved.

At home, you will finish writing your notes, read a little about the diseases you saw today and be ready for next week’s conference.

Tomorrow will be a new day, perhaps after a calm day you will run into an extremely busy day, it is precisely the unforeseen that makes your profession so exciting.

FAQS: Day in the life of a neurology resident

References

A Day in the Life of a Senior Neurology Resident | UAMS College of Medicine. (2020). Retrieved October 30, 2020, from College of Medicine website: https://medicine.uams.edu/about/features/a-day-in-the-life-of-a-senior-neurology-resident/

A Day in the Life of a PGY2 | Renaissance School of Medicine at Stony Brook University. (2020). Retrieved October 30, 2020, from Stonybrookmedicine.edu website: https://renaissance.stonybrookmedicine.edu/neurology/education/day-in-life-first-year-residents#:~:text=The%20day%20begins%20at%208AM,to%20two%20new%20consults%20called.

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