Junior Night Float [JNF] Rotation

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Faculty supervisors:

Dr. Alyssa Bautista and rotating faculty

PGY-2 Rotation

Description:

The PGY-2 resident rotates on the neurology ward services at Milstein Hospital in the evenings for six one-week blocks. The JNF resident functions as a hospitalist neurologist and performs several important duties, including:

evaluating and managing urgent neurological and medical problems that arise in hospitalized neurology patients;
admitting patients to the Hospitalist (“Grad”) Service and Epilepsy Monitoring Unit (EMU) Service overnight. The JNF resident makes independent initial assessments and management decisions for hospitalized and admitted patients, with supervision and back-up from the in-house PGY-4 Senior Night Float Consultation Resident, the in-house neuro-critical care or stroke fellows, and faculty on call.
some days of the week, the JNF resident also serves as ANF (see separate rotation description).

Evaluation:

Performance written evaluations are provided by the GenNeu/Stroke attending who receive the resident’s presentations using the electronic Medhub system. Verbal feedback is provided at the end of the rotation by supervising faculty.

Specific Objectives:

Patient Care

To admit patients transferred by their treating faculty neurologist.
To admit patients transferred from the Neurological Intensive Care Unit to the Hospitalist Service.
To elicit problem-focused neurological and medical histories from hospitalized patients on the neurology services of Milstein Hospital, Columbia University Medical Center.
To elicit a comprehensive neurological history on patients admitted overnight.
To recognize the symptoms and signs of neurological deterioration in hospitalized neurology patients or patients transferred from the NICU.
To demonstrate ability to follow clinical algorithms in the work-up of emergent problems in hospitalized neurological patients and patients transferred from the NICU, including new seizures, neurological deficits and alterations in mental status.
To generate a rational formulation, differential diagnosis, laboratory investigation and management plan.
To perform or arrange appropriate diagnostic testing, including lumbar puncture, radiographic imaging, or subspecialty consultation.

Medical Knowledge

To recognize the symptoms and signs of common of urgent neurological and medical problems.
To demonstrate clinical knowledge of acute and emergent neurological and medical conditions.
To demonstrate knowledge of common medical conditions that occur in patients hospitalized with neurological disease.
To become familiar with the neurological and medical issues in patients with acute neurological conditions who have been stabilized and transferred from the NICU to the hospitalist setting.
To identify and describe abnormalities seen in important and acute neurologic disorders on neuroimaging studies, including ischemic and hemorrhagic stroke syndromes, brain tumors, and demyelinating disease.
To recognize the symptoms and signs common neurological conditions, including neurological emergencies.
To become familiar with clinical neuroanatomy, and to use this knowledge as a basis for clinical reasoning.
To develop skill at making a well-informed synthesis of clinical information into a plan of immediate diagnosis and intervention.
To acquire knowledge of the pathophysiology and epidemiology of common neurological problems.

Interpersonal Skills and Communication

To develop and improve the interpersonal and communication skills, both written and oral, necessary to transmit an accurate neurological history, exam, clinical synthesis, and management plan to members of the ward service teams, attending neurologists, and nursing personnel.
To provide competent counseling to patients and families regarding neurological events, prognosis and management.
To develop skill at receiving, organizing and transmitting medical and neurological information into a succinct yet inclusive sign-out.
To establish effective communication with attending neurologists during the admission process for patients with acute or emergent neurological symptoms.
To interact and collaborate with nursing personnel in the assessment and management of acute medical and neurological problems in hospitalized patients.
To learn to document neurological and medical events, case summaries, and plans, in complete yet succinct problem-oriented form, using the hospital information systems.

Practice-based Learning and Improvement

To demonstrate the ability to reference and utilize electronic information systems to access medical, scientific and patient information.
To follow-up and reflect on the clinical outcomes of problem interventions and patient management decisions.

Professionalism

To demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a culturally and socioeconomically diverse patient population.
To respond in a timely manner to requests to evaluate acute medical and neurological symptoms in patients admitted to the neurology services.
To demonstrate appreciation of end-of-life care and issues regarding provision or withholding of care.

Systems-based Practice

Develop awareness of practice guidelines and protocols in the implementation of care for patients hospitalized on the neurology wards.
Utilize appropriate consultation and referral for the optimal management of patients with complicated medical illness.
Demonstrate awareness of the importance of adequate cross-coverage and availability of accurate medical data in the communication with and efficient management of patients under their care.

Updated 7/21/25