Moffitt Neurovascular Service (Neuro 140.12: ADVANCED NEURO CRITICAL CARE - Wade Smith, M.D. Ph.D.): This service consists of an attending, a stroke/neuro-critical care fellow, 1-2 2nd year residents, an emergency medicine intern and 1 or 2 MSIII students. There are typically between 12 and 20 patients on the service. Typical patients have suffered ischemic strokes, hemorrhagic strokes, or sub-arachnoid hemorrhages. There is also considerable exposure to neuro-interventional radiology patients. In addition to the educational conferences below, there are opportunities to attend neuro-interventional conferences, a noon-time journal club, and lectures for the service attendings. Pre-rounding begins between 6 and 7 AM (depending on census numbers), with rounds starting around 9 AM. The workday typically ends between 5 and 6 PM.
Moffitt Neurology Ward Service (Neuro 140.01A: ADVANCED INPATIENT - John Engstrom, M.D.) This service consists of an attending, a senior resident (R3 or R4), a junior resident, and 2 or 3 MSIII students. A typical census is 9-12 patients, consisting largely of transfers from other hospitals and direct admissions from our referral-based clinic. Typical patients have fulminant demyelinating diseases, myasthenic crisis, and rapidly progressive dementias. In addition to the educational conferences discussed below, attending rounds often includes a lecture by the attending. Pre-rounding begins early enough to finish by Work-rounds, which begin between 6:30 and 7:00 AM (depending on census numbers). Attending Rounds often run from 10AM until noon. The workday typically ends between 5 and 6 PM.
Moffitt Neurology Consultation Service (Neuro 140.01A: ADVANCED INPATIENT - John Engstrom, M.D.): This service consists of an attending, a senior resident (usually an R4), and occasionally, an internal medicine resident or emergency medicine intern. Between 8 AM and 8 PM, this service handles consultation requests from other hospital services, consultations from the emergency department and all admissions to the Neurology Ward and Neurovascular Services from the emergency department. There are typically 3 to 7 new consults during this time period, and around 10-15 patients being actively followed in the hospital. In addition to the educational conferences discussed below, the sub-interns on this service attend the various lectures on the Neurology Ward and Neurovascular services as time allows. The workday begins between 7 and 8 AM, and extends to between 7 and 8 PM.
SFGH Consultation Service (Neuro 140.10: CONSULTATION CLERKSHIP - Cheryl Jay, M.D.): This service runs nearly identically to its counterpart at UCSF (see above). Similarly, the workday begins between 7 and 8 AM, ending between 5 and 6 PM. In addition to seeing consultation patients, sub-interns on this service also see patients in the Wednesday and Friday New Patient clinics. This clerkship is usually reserved for UCSF medical students, but visiting students with a special interest in underserved populations may be interested. All requests for the Neurology Consultation Service at San Francisco General Hospital must be pre-approved. Visiting students should be aware that transportation to SFGH is very complicated without an automobile.
Call Requirements: All four rotations have identical call requirements. Each rotator will take 7 overnight calls, 2 of which will be 24-hour calls (Sat, Sun or holidays). Call at both sites is very busy, averaging 4 to 10 overnight consults/admissions. As a result, sleep is a welcome, but rare occurrence. Our sub-interns adhere to ACGME duty-hour requirements, including the 24+6 rule. Come to the first day of your rotation prepared to set your call schedule with the other sub-interns.
Time-off: San Francisco is a spectacular city to live in, and we’d like you to have time during your month to take in the sights. Sub-interns are given at least 4 days off during the month (depending on the service, there may be more). The residents and most sub-interns prefer to cluster these 4 days off into two “Golden Weekends.” Preferences for weekends off can usually be accommodated, but may need to be negotiated with your team and the other sub-interns.
Wednesday Educational Conferences: Each Wednesday afternoon, from 3:00 PM to 6:00 PM, residents, sub-interns and other medical students gather at UCSF for dedicated didactic time. A Clinic Case Conference occurs from 3 to 4 PM. The Division of Child Neurology presents from 4 to 5 PM. The 5 to 6 PM hour is occupied by our Department’s Grand Rounds or a Housestaff teaching conference depending on the week.
Site-specific Educational Conferences:
Morning report: At UCSF, the residents (and sub-interns) meet for one hour with various faculty members to discuss an interesting case in detail. This occurs three mornings per week. At SFGH, morning report occurs every weekday morning.
Professor Rounds: one morning a week, a senior faculty member meets with all residents and medical students to hear an interesting case and take us to the bedside for exam skills and teaching.
Neuroradiology Conference: one morning a week, the Neurology, Neurosurgery, and Neuroradiology departments convene to see the most interesting and perplexing imaging studies.
Outpatient Opportunities: Some sub-interns want to spend time in one of our distinguished outpatient clinics (the Memory and Aging Center, the Multiple-Sclerosis Center, the ALS Center, to name a few).
Days spent in these clinics are most easily arranged just before or after your month rotation. If this is not possible, you can work with your assigned attending and resident to find a mutually convenient time for such a visit.
