A Day in the Life of a Chief Neurology Resident: Dr. Ali Daneshmand

A DAY IN THE LIFE OF A CHIEF NEUROLOGY RESIDENT: DR. ALI DANESHMAND

If it’s 7:00 a.m. and you’re the chief resident in neurology at Tufts Medical Center, you know where you’re going to be: Standing bright-eyed and alert with the float residents to learn what happened with neurological patients overnight. Even if your call the night before robbed you of some sleep while you coached a junior resident through a difficult case, you’ll be ready for a day of meetings, rounds, and patient care.

Here’s how a typical day goes for Chief Resident Ali Daneshmand, MD, MPH:

• 7:00 a.m.—Signout, the meeting where float residents supply the “day crew” with the briefing on the night’s activities.
• 7:30 a.m.—Morning Report, where the night float residents present a case with the faculty in an interactive discussion.
• 9:00 a.m. —An interdisciplinary team meeting with social workers, physical therapists, nursing staff, and others to discuss all the patients in the team’s care for the day.
• 9:30 a.m. —Rounds, which usually last until noon, including a professor round at 10:30 where the residents present a case to Dr. Thomas Sabin to get extra insights and training.
• 12:00 p.m.—Lunch, eaten while hearing a subspecialty presentation.
• 1:00 p.m.—Clinical duties, including new consults, discharges, documentation.
• 5:00 p.m.—Another meeting to discuss the patients, this time with the junior residents and attending physician.
• 5:00 p.m.–7:00 p.m.—One resident stays until the float residents start again overnight; the chief resident might also stay to complete documentation or other duties.
• By 7:00 p.m.—The chief resident is home on call, prepared to discuss cases with the overnight residents as needed; typically one or two conversations a night for Daneshmand.

If that sounds intense, consider that it is only the daily schedule. In addition to these duties, there are weekly and monthly obligations as well: Regular contact with the junior residents to check on their personal and professional concerns; a blog and a weekly Chief’s Letter that includes educational opportunities and bulletins; outreach to speakers for the noon luncheon presentations; meetings with prospective residents during interviews and dinners. Daneshmand says it was all pretty overwhelming when he started the role last June, but it’s become less so as he’s gotten used to the pattern. It also helps that Tufts’ 16 residents are directed by two co-chiefs who rotate some duties on a monthly basis, giving each a chance to dig into other projects, as well.

Daneshmand is especially glad to have gained this experience teaching and developing curriculum because his future goals include those roles. “The main reason I applied for the position is because I’m very interested in education,” he says. He also wanted to test his capacity for leading and being responsible for others—an experiment he is happy to say is turning out well. “I’ve actually liked it a lot,” he reports. “I’ve enjoyed working with the program, the attendings, the residents. It’s been eye-opening because a lot of it is different from what I was expecting at the beginning of the year, but I’m learning a lot from the process.”

One of the things Daneshmand says he thought would be different was the level of training specific to being chief resident. In essence, there isn’t any, although there’s plenty of support. “The interesting thing as there is no certain track for being chief resident in neurology,” he notes. “You just sort of get thrown into the situation. But on the other hand, I’ve found that the trust the program has in me is really encouraging. I’m very grateful to the program for that.”

On that note, Daneshmand advises that prospective chief residents prepare themselves by taking leadership roles early in their programs to show they can stand out as leaders. “Especially in our field of neurology,” he says, “people need to believe that the chief is clinically sound and knowledgeable. Otherwise, it would be hard to convince other people to follow what you’re saying in terms of scheduling or difficult decisions. It’s also really important to build relationships with the residents, so you need to be approachable and not let things turn into power struggles.”

More advice for potential chief residents? Daneshmand believes in the value of work/life balance, even with a limited budget of free time. For his part, he keeps a standing commitment to go to the gym with his wife every other day and meets friends for dinner as often as he can. Now, as his leadership year draws to a close, he’s finding it easier to maintain the balance. While that’s partly because he’s become more adept at managing the multiple roles, it’s also due to the program’s structure, which is intentionally frontloaded with the most intense work in the first two years. The chief residents catch another break, in that next year’s leaders take the reins in June, allowing the outgoing leaders a month to wrap up and prepare for the next stage in their careers. For Daneshmand, that will mean a move across the country to Mayo Clinic in Rochester, MN, where July will find him beginning his fellowship in neurocritical care. It’s a chance to be the beginner yet again in a training program, but one which he welcomes. “I certainly do not feel exhausted or burned out,” he says. “I’m excited to get to the next level in my training.”