For the next week of the rotation, I spent 3 days on the adult consult team and 2 days on the child consult team. The student I was with on stroke did consults the same week as me, and since we’re both interested in pediatrics we divided the week up so both of us could have exposure to both sides of the service.
On the adult side, the team meets in the morning to go over the most recent list of patients whom neuro was consulted for but who have not been seen by an attending physician. The team splits up to see those patients as well as any new consults in the morning. Then they round on all of those patients with the attending in the afternoon. However, due to the attendings’ varied clinic schedules and other duties, and due to the sheer size of the patient census, the team often rounds until late in the evening–sometimes until 9 or 10 pm. During all of this, a representative from the consult team is also expected to go to stroke alerts when they come in. As you can guess, the adult consult team is extremely hectic, so there is often not much time for the residents to formally sit down and teach medical students–in fact, it can be difficult for medical students to see patients alone because the residents have to be efficient and get their work done. Some of my peers get really frustrated when there is no time for them to independently take a history and do a physical exam, or to present the patients they saw on rounds. However, I have tried to see every moment as a learning experience if I can, even if I am simply watching a resident do a neuro exam. This mentality worked well for me in this setting: I could honestly say that I learned quite a bit from the team in the short time that I spent with them.
I enjoyed my 2 days on child consults as well–I love a good excuse to spend time in the Children’s Hospital! The mornings were earlier than on adult consults (6:30 instead of 8), and a bit more structured. The neuro consult resident and I reviewed EEGs with one of the epilepsy attendings, rounded in the Peds ICU and with the Epilepsy Monitoring Unit team, and saw quite a few children (and their parents) come through the ED for complaints such as headaches, limb weakness, and lethargy. When there was downtime, the neuro residents gave me topics to read about and taught me things that would be useful on the wards and on the shelf exam.
Despite the very limited time that I spent with both consult teams that week, I feel like I saw quite a variety of problems and was allowed to be fairly independent when schedules permitted.