A Day in the Life of a First Year Resident...
The first year of neurology (PGY-2) at Stony Brook is divided into six main rotations, and a typical day for each is listed below. All of your time is spent at Stony Brook University Medical Center unless otherwise noted.
General Neurology (~10 weeks):
All neurology admissions other than strokes or TIA’s are admitted to the general team, which consists of a PGY-4 neuro resident, a PGY-2 neuro resident, the attending, and medical students. Your day begins at 7:30AM with morning report where the overnight cases are presented. On most days a lecture follows, and by 9AM you hit the floor and start seeing patients. Rounds with the attending usually begin around 11AM, and we typically have four to ten patients on the general service at any given time. Rounds are usually completed in the early afternoon, and you have the rest of the day to complete your work. All discharges and dictations will be completed, lumbar punctures are performed if needed, neuroradiologists are available to review films, and all other tasks are finalized. Sign-out to night float occurs at 6PM.
Stroke Neurology (~6 weeks):
All strokes, hemorrhages, and TIA’s are admitted to the stroke team, which consists of a PGY-2 neuro resident, a stroke nurse practitioner, the attending, and medical students. Your day begins at 7:30AM with morning report where the overnight cases are presented. On most days a lecture follows, and by 9AM you hit the floor and start seeing patients. Rounds with the attending usually begin around 10AM, and we typically have four to ten patients on the stroke service at any given time. We have a four-bed stroke unit where our most critical patients will be admitted. Patients will go there after the administration of tPA, if they require pressors or continuous drips, or if they just need close monitoring. Additionally, a full-time neuro ICU is currently in the planning stages. Again you will have the afternoon to complete all of your work, and sign-out to night float occurs at 6PM.
Veterans Affairs (VA) Hospital (~10 weeks):
The VA rotation consists mostly of outpatient office-based care in the Veterans Affairs Hospital in Northport, NY. The team consists of a first, second, and third year neurology resident as well as a rotator from psychiatry. The first year resident is responsible for any patients admitted to the floor, and typically the neurology inpatient census is small. By far the majority of the time is spent in the clinics, which are held Monday through Thursday. The day begins at 8AM with patients seen throughout the morning, and the afternoon visits usually end between 4:30 and 5:00. Every Tuesday, all residents report to Stony Brook for morning lectures and then the VA residents proceed to Northport for afternoon clinic. On Friday, all residents again report to Stony Brook for morning lectures which are followed by our Stony Brook continuity clinic on Friday afternoon.
Consults (~6 weeks):
Your day begins at 7:30AM with morning report followed by one or two lectures. You will then assist the second year neurology resident with the consult service. The second year resident—along with a stroke and a general attending—directs the consult service. All emergency room consults (and potential admissions) as well as consults from other services are managed by this team. All neurology follow-ups on other floors are also seen by the consult service. It is one of our busiest rotations, seeing anywhere from five to fifteen new consults throughout the day. Per our residents, it is typically one of the best learning experiences. The role of the first year is to assist the senior resident by performing new consults or seeing follow-ups. Sign out to night float occurs at 6PM.
Ambulatory Rotation (~6 weeks):
While on the ambulatory rotation, you come daily to Stony Brook at 7:30AM for morning report followed by a lecture. Once lectures are over at 9:00AM, you head over to our outpatient clinic which is five minutes away. You will either see your own personal continuity patients or have the opportunity to participate in one of our attending-run specialty clinics such as ALS, sleep, or multiple sclerosis. On Monday and Tuesday afternoons, the ambulatory rotator heads over to the VA in Northport to assist with their afternoon clinics. Every Wednesday morning lumbar punctures are scheduled, where you will get to perform two to four LP’s. On Fridays you will spend your morning in lectures at Stony Brook, and in the afternoon you will join the senior on the consult service. While on the ambulatory rotation, you do not have Friday afternoon continuity clinic because you have already seen your own patients during the week. The typical day ends between 4:00 and 5:00.
Night Float (~10 weeks):
Night float is Sunday through Thursday, and your shift starts at 6PM. You are responsible for all in-house consults (both pediatric and adult) and neurology admissions while on-call overnight. During the week, a senior resident will stay with you until 9PM to help out with consults, and then he or she is available all night from home as back-up. Attendings are also in-house in the evening to see patients with you, and then are accessible during the night to discuss cases. All cases are presented to an attending prior to creating a final disposition. Morning report is at 7:30AM in which all of the cases from the night before are presented, and your shift ends at 8AM. Night float occurs in very manageable one to two week blocks.
Every Friday afternoon, all residents attend our continuity clinic where you will typically see four to six patients. Our patient population is diverse and includes individuals with multiple neurologic ailments. The examination rooms are fully equipped with all that you will need for your exam, and all cases are presented to an attending who will then examine the patient with you. You will make your own management plan and the attending is available for guidance. The most important aspect of continuity clinic is that these patients truly become your own, and you will continue to follow them throughout your three years at Stony Brook.
Weekend call is broken up into three different shifts. The Friday night person covers from 5PM Friday to 7AM Saturday. A senior resident stays with you until 9PM to help with consults, and is available as back-up from home the rest of the night. Saturday call starts at 7AM and goes until 7AM on Sunday. You and a senior resident round with the attendings and write notes on our own neurology inpatients, and then the junior resident covers consults for the rest of the shift. The senior resident stays most of the day and leaves on Saturday evening at 6PM, taking back-up call from home. The next team comes in at 7AM on Sunday, receives sign-out from the Saturday resident, and then the new team rounds with the attendings and writes notes on our inpatients. The junior stays to cover consults until the night float resident comes in at 6PM. Again, the senior resident is available from home as back-up, and an attending is available at all times. In a typical month, you will be on-call for three weekends and have one weekend off.