INPATIENT PEDIATRIC NEUROLOGY

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					INPATIENT PEDIATRIC NEUROLOGY
Description
          This is a 2 week rotation at St. Louis Children's Hospital. Pediatric Neurology has its own inpatient service in this
hospital, which is different than many hospitals where Pediatric Neurology is purely a consult-based service. It is an
excellent learning experience because we are primarily responsible for taking care of acutely ill patients. The Pediatric
Neurology inpatient service is on the 12th floor at SLCH, as well as pediatric neuro-rehabilitation service and many
neurosurgery patients.
          The structure is that there is a team of pediatric residents (usually 4-5 interns and a senior resident) working
directly with the pediatric neurology fellow and attending physician. Medical students on the Pediatric clerkship no
longer have the option to be assigned to the 12th floor because of the specialty nature of the patients. Therefore, the only
medical students are from the Neurology clerkship.
          Medical students work directly with the pediatric neurology fellow and the senior pediatric resident on the floor.
At the discretion of the supervising team, they will work up and follow pediatric neurology patients. In addition to the
inpatient service, pediatric neurology has a busy consult service providing input for patients on other services throughout
the hospital including the neonatal intensive care unit, the pediatric intensive care unit, and the emergency department.
The pediatric neurology fellow will decide when it is appropriate for the medical student to see patients off of the
inpatient service.
          Call is every 4th night. You can use the NICU call rooms. Please write your name on the calendar that is on the
door in the call room.
          Round Structure:
     1. 	 Work rounds start at 0800 on 12W. The team includes pediatric interns, pediatric senior resident, pediatric
          neurology fellow, 12W charge nurse, neurology social worker, 12W house staff assistant, neurology pharmacist,
          and others. The purpose of work rounds is to ascertain the status of current and new patients, and formulate the
          plan for the day. Some teaching occurs on work rounds at the discretion of the pediatric resident. Medical
          students should arrive sufficiently early to pre-round on their patients so they can be an active part of work
          rounds.
    2. 	 Attending rounds usually occur 2 days per week in the late morning. The precise schedule is determined by the
          attending physician.
    3. 	 Dodge rounds: Dr Dodge is an emeritus professor of pediatric neurology and one of the founders of modem
          pediatric neurology. Each Wednesday from 10:30-noon he meets with the 12W team to go over a patient. This is
          a particularly enjoyable experience.


Schedule
M-F (varies)                      Preround (by 0750 on M,W, Th, F and 0650 on Tuesday. Work rounds on 12 Ware at
                                  0800 on M, W, Th, 0830 on T (after Peds Neuro Conference). On Friday attend
                                  Neurology Grand Rounds 0800-0900 unless cancelled. Check with the pediatric
                                  neurology resident for resident for details.
Tu Clinic                         Pediatric Neurology Clinic, I :00 pm, 2 West

The following conferences are required:
Monday                          Team-Based Learning Conference, Choi Conference Room, 11 :30 - 1:00
                                Epilepsy Conference, 3rd floor boardroom SLCH, 2:30-3:30pm
Tuesday                         Neurosurgery Student Conference, 7 - 8, McMillan 5th Floor
                                Pediatric Neurology Divisional Conference, 7:30 - 8:30am, PL26 SLCH (go here after
                                         Neurosurgery Student Conference)
                                Clinical Conference, 12 - 1, Schwartz Auditorium
Wednesday 	                     Professor's Rounds with Dr. Dodge, 10:30-noon, 12E25 conference room SLCH
                                Team-Based Learning Conference, Choi Conference Room, 12 - 1:30
                                Dr. Landau's Ethics Conference followed by Course Evaluation, 4 - 5:30, last
                                    Wednesday of the block only, McMillan 3cd floor Conference Room
Thursday                         Dr. Naismith's CME Rounds, 7:30 - 8:45, Choi Conference Room
                                 IfCME Rounds cancelled: (Pediatric Neuroradiology Conference, 7:00-8:00 am, 3rd floor
                                         boardroom SLCH)
                                 Dr. Goldberg's Neurology Essentials, 12 - 1:30, Hope Center Conference Room
Friday                           Neurology Grand Rounds, 8 - 9, West Pavilion Auditorium

Expectations
         You should be working-up 3-5 new patients each week under the direction of the pediatric neurology fellow and
senior pediatric resident. Most of these will be done independently, but there will be situations when you might work-up a
patient together with the resident and/or fellow. Do not wait for an 'interesting patient' or a 'ward patient'. Don't worry if
you already had a patient with that complaint or diagnosis.
         In general, you should take your time when talking with your patients and examining them. Sometimes there
might be some time constraints, and your resident will let you know when you have to be most efficient. With no
constraints, it might take 1 - 1.5 hours for a complicated patient. For your admission work-up, you should strive to be
complete and thorough. The most important issue is to have a clear assessment and plan formulated so that your
admission orders can be written, assessed by the resident/fellow, and co-signed. Next, work to get your admission note
completed. At SLCH, pediatric interns, pediatric residents, and the pediatric neurology fellow all must write notes.
Often, the medical student note provides a level of detail not available elsewhere. Work to write an excellent and timely
note. It should go into the chart after the pediatric neurology fellow or senior pediatric resident has assessed it.
         You should pre-round on your patients each day. See each patient and do a pertinent, hypothesis-driven
neurologic exam. If you are not sure what is pertinent, then lean more towards being complete. After presenting the
patient on work rounds, a daily plan will be formulated. You should have your own notion of the plan in your mind rather
than wait to hear what others have to say. After the plan is in place and after rounds are over, write the orders and be sure
to have them assessed and co-signed by your resident/fellow.
         After the note is complete and plan was discussed, you should write the orders for the day. This includes
medications, labs, tests, and consults with therapists. Have your resident review the orders and cosign them. You should
also be helping with admission orders on new patients.
         When on-call, stick with the pediatric neurology fellow if he/she is in house, or with your senior pediatric resident
when you are not working-up your own patients.
         If things are slow on the pediatric neurology inpatient service, then your fellow may ask you to see a consult on
another service. The neurology fellow and the senior pediatric resident should discuss that you will be going to work-up a
patient elsewhere, and you should have all the work done on your patients so that you can do this.
         You should not ever be expected to perform menial (aka "scut") work unless it has clear educational value or
allows your resident/fellow to be freed up so that there is more teaching time. For example, you should not ever be
expected to fetch snacks for the team.
         There are people on the floor that assist in evaluating patients and helping with their discharge. Therapy includes
Physical Therapy, Occupational Therapy, Speech/Swallowing/Cognitive Therapy. You should read their notes so you can
know about disposition and recommendations.
         Be involved in discharging your patients. SLCH has house staff assistants who are extremely helpful. But it is
important to understand the logistics of patient disposition so be involved in the process.

				
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posted:8/5/2011
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