UH Neurosurgery Tips:

Presenting on Rounds:
1. Rounds start at 6 am Mon-Tues-Thu-Fri, 5:45 AM on Wed because of conference, and 7 AM on
Weekends
2. Plan to pre-round and present on 1-2 patients daily, usually patients whose cases you were involved in
the day before
3. When you arrive in the morning, grab a copy of the list from the NSU front desk and check the master
list to find out which resident is covering your patient(s). Be sure to ask the resident if it’s ok to present
their patients before rounds start! Do not miss your chance to present patients on rounds.
4. Patients in the NSU (essentially the Neuro ICU) are sicker and will have more complicated presentations
and plans than patients in the NIU
5. When presenting:
• SOAP format with objective portion organized as follows: Vitals, I/Os, PE, Labs
• Aim to keep presentations under 1 minute
• Always include Foley and drain outputs/properties (clear/blood/serosanguineous)
• Relevant exam findings only
i. Always include level of consciousness - GCS if needed
ii. Focus your presentation of physical findings to patient’s pathology (i.e. s/p spinal surgery
emphasize patient’s strength grading and dermatome exam, don’t include unnecessary
details like CNs)
iii. Tip: If presenting on an NSU patient ask nurses to turn off sedation so you can do your
exam!
• Assessment/Plan: this is how to demonstrate your clinical knowledge/reasoning
i. It usually will be outlined in the patient list, however, it is your job to comment on WHY
(i.e. cycle O2 in order to help resolve pneumocephalus)
ii. Basic outline for Plan:
1. What are we doing with this patient? What is the goal?
2. What recs are we waiting for?
3. Nutrition status?
a. Dobhoff/PEG?
4. Disposition
a. SNF/Rehab/LTAC?
b. Transfer to NIU?
• Tip: Know patient’s anticoagulation/antiplatelet status and if they are on any DVT prophylaxis
Cases:
• Watch these videos on how to scrub in before your first day
o https://www.youtube.com/watch?v=xLIFT9xoWSQ
o https://www.youtube.com/watch?v=nItDnAgZqZY
• Look up cases the day before; the schedule is pinned in the team room every Monday morning
• Practice one-handed knot ties (Youtube) and ask residents if you can throw some knots when they’re
closing
• Visit patient in preop, introduce yourself and then head to the operating room
• Help the nurses/resident prepare the patient for surgery and then ask the resident to scrub in
• Even if you don’t get to do much it is easier to observe the surgery from the sterile field!
• If you know how to tie the residents will often let you throw a few knots when closing
• Be sure to stick around after closing to help transport the patient to the PACU

Miscellaneous:
• There isn’t much to do for medical students on the floor, however, go back to the team room after cases
and see if there are any random tasks that you could do
 • Know ICH score and NIHSS as these come in handy if you ever go to the ED to evaluate a patient
• Between rounds and the start of cases there is a bit of down time when lines and drains are usually
pulled---Go with a resident during the first couple days to learn how to do this

Acknowledgements:

Thanks to Nihar Shah, Class of 2020, for creating this guide.