Faculty supervisors:
Dr. Alyssa Bautista and rotating faculty.
PGY-4 rotation (PGY-3 on weekends)
Description:
The senior night float role is considered to have the highest level of responsibility and independence in medical decision-making in the Neurology Residency Program. The resident carries the consult pager and is the most senior neurology resident in the hospital overnight. The senior night float is responsible for evaluating and recommending a plan of diagnosis and management for patients with acute and emergent neurological problems who present to the Department of Emergency Medicine, or who are already hospitalized on other services at the medical center. This individual also serves as in-house consultant to the admitting and cross-coverage (junior) night float residents. The senior night float is supervised by the attending neurologist on-call, and also receives support and expertise from the in-house neuro-critical care and stroke fellows, as needed. The decision to discharge a patient from the emergency room is discussed with the consult attending. The ability to fill this role represents an important milestone in the development of an independent neurological consultant.
The senior night float assumes the consult pager at 7:00 pm, and provides consultation overnight. All consultations are appropriately documented, and the senior night float presents the histories, examination findings, laboratory data, synthesis, plan of management and disposition to the consult attending and the consult team in the morning from 8:00- 9:00am.
Evaluation:
Performance written evaluations are provided by the Consult morning attending, who receive the Consult resident’s presentations on morning rounds using the electronic Medhub system. Verbal feedback is provided at the end of the rotation by supervising faculty.
Specific Objectives:
Patient Care
To obtain a complete neurological history and to perform a comprehensive neurological examination on patients presenting overnight to the Department of Emergency Medicine with acute neurological symptoms.
To obtain a complete neurological history and to perform a comprehensive neurological examination on patients hospitalized on other medical services and intensive care units throughout the medical center who develop acute neurological symptoms.
To develop and implement a comprehensive plan of diagnostic testing, therapeutic management and disposition for patients presenting with acute neurological conditions.
To develop and refine an approach to the evaluation and treatment of neurological emergencies, including stroke, seizure, and alterations in consciousness.
To create a complete, rational and independently-formulated synthesis of each case for presentation at morning rounds to the consult service.
Medical Knowledge
To expand knowledge of a full range of neurological conditions, including neurological emergencies in adults.
To demonstrate an expanded knowledge of the pathophysiology and epidemiology of acute neurological problems, including stroke, seizure and status epilepticus, alterations of mental status and coma.
To refine the skill of making a well-informed synthesis of neurological history, examination and laboratory data, and a sophisticated differential diagnosis, diagnostic and therapeutic plan.
To identify and describe abnormalities seen in important and acute neurologic disorders on neuroimaging and neuro-physiology studies.
Interpersonal Skills and Communication
To present a complete summary and synthesis of new consultation service patients at morning rounds for review by the consultation service attending.
To write a comprehensive, problem-oriented consultation note on patients admitted to the neurology inpatient services overnight.
To interact and communicate effectively and compassionately with patients and family members in a professional, ethical and culturally sensitive manner.
To improve skill in communicating with patients who have neurological impairment.
To improve and refine the interpersonal and communication skills, both written and oral, necessary to
- communicate with other physicians,
- present cases on rounds and in conferences, and
- to provide competent counseling to patients and families.
Professionalism
To serve as an effective neurological consultant, competent to admit and manage the care of patients with neurological disease while demonstrating the professional attributes of integrity, empathy, and compassion.
To serve as a knowledgeable and supportive in-hospital consultant for the junior admitting night float.
To show appropriate respect for and cultural sensitivity to patients and their families.
To demonstrate an appreciation for end-of-life care and issues regarding consent, competence, advance directives, do not resuscitate orders, and the provision or withholding of care.
To be compliant with ethical and legal standards, work hour guidelines and the requirements of patient confidentiality.
To demonstrate appropriate respect for the opinions of other physicians in the evaluation and management of patients with neurological illness.
Systems-Based Practice
To demonstrate the ability to interact with many other entities and services within the medical center, including the Departments of Emergency Medicine and Radiology, in the urgent evaluation, treatment, and admission of patients with acute neurological conditions.
To demonstrate the ability to reference and utilize electronic information systems to access medical, scientific and patient information
To develop awareness of hospital protocols, triage guidelines and standards of practice that have an impact on the evaluation and management of patients with acute neurological problems.
To become adept at making triage decisions and urgent diagnostic and management recommendations for patients with acute neurological problems.
To develop effective time management and triage skills in responding to demands for neurological consultation.
Practice-Based Learning and Improvement
To refine the use of the medical literature, including electronic databases, in the application to patient care and neurological education.
To become adept with hospital information systems in the evaluation and treatment of neurological patients.
To develop an appreciation for the clinical trials and evidence-based medicine that informs the management of neurological problems.
Updated 7/21/25