Ask a neurosurgery resident anything

[Omppu27]

Might have been asked before in the thread, but what's the most interesting case you've seen during your NS residency?

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[studentp0x]

Longest you've ever been in the hospital in one go? Longest go without sleep?

 

[neusu]

Hey thanks for doing this! My questions might sound stupid btw

I don't have any dreams of neurosurgery or anything of that sort yet but I saw a post last year about neuroscience major....and I was a neuro major so my question is....if I didn't end up "loving" (but not hating) the brain after taking a bunch of neuro courses in UG, would I not "fit" in neurosurgery? Or should I just keep an open mind when/if I'm in med school?

my other q is were you a morning person during college and/or before/during med school? I am really bad at getting up in the morning (830 am or earlier). If you weren't originally a morning type, was it difficult to adapt to that lifestyle of getting up very early?

Oh and last q: Do you know any surgery residents (any field) who have ADD? If so how does it affect their ability to function?

Thanks!

With respect to your first question, I would keep an open mind even if you end up "loving" the brain. You are apt to change your specialty interest along the way for a number of reasons (interests, personal concerns, competitiveness). Also, being pegged as "only interested in neurosurgery" can be a bad thing as well. Most physicians at academic centers are at least mildly interested in their field and enjoy teaching it to those who show interest. Having a preconceived notion that you have no interest can have a negative impact on their perception of your ability to perform on their rotation.

I was never a morning person, but could always get up and get the job done. I'd pick classes to be able to sleep in and stay up late because of my natural rhythm. Some of my lab or recitation sections met at 7:30 AM. Medical school and residency force you to adapt to getting up early. On my surgery rotations we had to be at the hospital for pre-rounds before 5 AM and often had to stay late for cases.

I personally do not know of any surgical residents with ADD, but then again I haven't had the need to know. If it is appropriately managed it shouldn't be much of an issue.

 

[bear2roo]

With respect to your first question, I would keep an open mind even if you end up "loving" the brain. You are apt to change your specialty interest along the way for a number of reasons (interests, personal concerns, competitiveness). Also, being pegged as "only interested in neurosurgery" can be a bad thing as well. Most physicians at academic centers are at least mildly interested in their field and enjoy teaching it to those who show interest. Having a preconceived notion that you have no interest can have a negative impact on their perception of your ability to perform on their rotation.

I was never a morning person, but could always get up and get the job done. I'd pick classes to be able to sleep in and stay up late because of my natural rhythm. Some of my lab or recitation sections met at 7:30 AM. Medical school and residency force you to adapt to getting up early. On my surgery rotations we had to be at the hospital for pre-rounds before 5 AM and often had to stay late for cases.

I personally do not know of any surgical residents with ADD, but then again I haven't had the need to know. If it is appropriately managed it shouldn't be much of an issue.

Thanks for your reply! I'll keep it open on the chance I do get interested in the future.

The morning thing has always bothered me...I try to get it fixed but it's hard for me to sleep before 1am T__T even if I wake up at 730am for work. Peopple telling me about surgery rotation scares me since I'm so bad at waking up and my dad who's a physician is always wondering how I can survive med school/being a doctor if I can't get up before 9am naturally >.<

 

[FK1989]

Hey
i recently graduated from a non EU medical school and iam not an EU national. Iam planning on completing my intern year in my home country as it is recognized by the Irish medical council.
Iwant to start my residency training in Ireland,the problem is i want to get a decent training programme in neurosurgery
I really want to know how hard it is and if its ever even possible to get into it?

 

[neusu]

Might have been asked before in the thread, but what's the most interesting case you've seen during your NS residency?

This is tough to say, I have been involved in some great cases throughout my residency and different cases are interesting for different reasons. I'm partial to vascular and skull base, so some of the more extended skull base aproaches or vascular resections/reconstructions are up there.

 

[neusu]

Hey
i recently graduated from a non EU medical school and iam not an EU national. Iam planning on completing my intern year in my home country as it is recognized by the Irish medical council.
Iwant to start my residency training in Ireland,the problem is i want to get a decent training programme in neurosurgery
I really want to know how hard it is and if its ever even possible to get into it?

I'm not very familiar with neurosurgery training outside the US. Certainly, there are good programs out there. Getting in to a US training program as an IMG/non-citizen is fairly difficult

 

[neusu]

Longest you've ever been in the hospital in one go? Longest go without sleep?

This is a tough one. I spent 9 days straight in the hospital once, fortunately they have showers and provide scrubs! Longest without sleep at all was probably 42 hours. Longest with minimal sleep (<30 min at a time) was 72.

 

[Omppu27]

This is a tough one. I spent 9 days straight in the hospital once, fortunately they have showers and provide scrubs! Longest without sleep at all was probably 42 hours. Longest with minimal sleep (<30 min at a time) was 72.

Oh. My. God.

 

[Omppu27]

This is a tough one. I spent 9 days straight in the hospital once, fortunately they have showers and provide scrubs! Longest without sleep at all was probably 42 hours. Longest with minimal sleep (<30 min at a time) was 72.

Honestly, how do you not go insane? I'm assuming while you're awake during those 9 days you're busy the whole time, but still....

 

[Remy LeBeau]

Hi. Thanks for doing this Q&A!

I have heard that ageism is alive and well in reviewing medical students for residencies, especially the longer surgical residencies, since older students won't have careers that are as long as their younger counterparts. As a non-trad student interested in surgical specialties who will be almost ten years older than my classmates, is this something I should really be concerned about, or is this age discrimination thing overblown?

Thanks!

 

[soccerusa]

Hi! I had a quick question. How much mortality does neurosurgery deal with? For example, how often does one of your patients die on the table or postop during residency?
Thanks for your time on this thread.

 

[neusu]

Honestly, how do you not go insane? I'm assuming while you're awake during those 9 days you're busy the whole time, but still....

Busy the whole time. Fortunately, we have a call room with an extra bed!

 

[Omppu27]

Busy the whole time. Fortunately, we have a call room with an extra bed!

Hahaha man, you rule.

 

[FK1989]

I'm not very familiar with neurosurgery training outside the US. Certainly, there are good programs out there. Getting in to a US training program as an IMG/non-citizen is fairly difficult

Oh iam sorry for that...umm okay so in US how hard is it? i mean does it happen ever? for an IMG to get into a neurosurgical training program?? and what USMLE scores should one target? Also thanks alot for your help, iam sure being in a NS training programme and finding time to answer these questions must be very difficult

 

[neusu]

Hi. Thanks for doing this Q&A!

I have heard that ageism is alive and well in reviewing medical students for residencies, especially the longer surgical residencies, since older students won't have careers that are as long as their younger counterparts. As a non-trad student interested in surgical specialties who will be almost ten years older than my classmates, is this something I should really be concerned about, or is this age discrimination thing overblown?

Thanks!

Age does play a minor role in our decision making process. Too young and you tend to be too immature to handle the emotional intensity of some of our pathology. Too old and the schedule can be too rigorous. I know I fatigue more now as a senior resident than I did as a junior. I couldn't imagine starting 5-10 years later.

 

[lenovofan]

Age does play a minor role in our decision making process. Too young and you tend to be too immature to handle the emotional intensity of some of our pathology. Too old and the schedule can be too rigorous. I know I fatigue more now as a senior resident than I did as a junior. I couldn't imagine starting 5-10 years later.

Would you please explain what starting age you are referring to as "couldn't imagine"? I know it probably depends on the person, but would you consider, if one is aiming for a neurosurgery career, starting med school at 30 kind of late or too late?

 

[EMDO2018]

Neusu...what was your MCAT score? Just Curious.

 

[sinombre]

Neusu...what was your MCAT score? Just Curious.

I'm pretty sure it was already posted in this thread.

 

[neusu]

Hi! I had a quick question. How much mortality does neurosurgery deal with? For example, how often does one of your patients die on the table or postop during residency?
Thanks for your time on this thread.

We do deal with a fair amount of morbidity and mortality intrinsic to the pathologies. We've had one patient die on the table, but typically will close and push to get unstable or destabilizing moribund patients to the icu. No one enjoys it, but having family meetings and breaking bad news is something we do often. The human body can only handle a limited amount of trauma and we as surgeons are also limited in what we can do.

That being said, the vast majority of our elective cases, and our practice in general, go smoothly and our patients are happy.

 

[NoPeace]

On average, how many chicks do you reel in per week? How do they react after you tell them your a neurosurgeon? How do you sift through the gold diggers? Thanks.

 

[neusu]

Thanks for your reply! I'll keep it open on the chance I do get interested in the future.

The morning thing has always bothered me...I try to get it fixed but it's hard for me to sleep before 1am T__T even if I wake up at 730am for work. Peopple telling me about surgery rotation scares me since I'm so bad at waking up and my dad who's a physician is always wondering how I can survive med school/being a doctor if I can't get up before 9am naturally >.<

Adjusting to the earlier schedule comes rather quickly when it becomes a necessity. Try shadowing a doctor or resident for a couple of weeks. You'll see that your natural schedule switches to falling asleep earlier and waking up earlier.

 

[stronghold]

Are you RS? If I got you, I would remove the post

 

[sinombre]

Just stumbled across this short article titled "Novice Neurosurgeons Train On Brains Printed in 3-D":

http://www.npr.org/blogs/health/201...-neurosurgeons-train-on-brains-printed-in-3-d

Is it really a novel idea? Do you or have you used anything similar in the past?

 

[Funke]

What do you think of CTFxC's youtube post "MAN FILMS OWN BRAIN SURGERY." If anyone hasn't seen it, this popular YouTube blogger has a brain tumor, and the surgeons let him film and vlog the whole thing. It also turns out it was malignant, and he's now vlogging his chemo process. He wants to encourage other people going through the same thing.

Would you let a popular YouTuber film your surgery and post it for millions to watch?

 

[neusu]

Oh iam sorry for that...umm okay so in US how hard is it? i mean does it happen ever? for an IMG to get into a neurosurgical training program?? and what USMLE scores should one target? Also thanks alot for your help, iam sure being in a NS training programme and finding time to answer these questions must be very difficult

In the US residency is very hard to get in to neurosurgery in general, and even harder for an IMG. Generally, for US students, I recommend aiming for >240 and > 250 for IMGs. Likewise, doing rotations to receive letters and doing research and publishing for your CV. It's a competitive field.

 

[DrCharlemagne]

Would you please explain what starting age you are referring to as "couldn't imagine"? I know it probably depends on the person, but would you consider, if one is aiming for a neurosurgery career, starting med school at 30 kind of late or too late?

+1 as someone who has been told by several neurosurgeons I should look into the field.

 

[neusu]

Would you please explain what starting age you are referring to as "couldn't imagine"? I know it probably depends on the person, but would you consider, if one is aiming for a neurosurgery career, starting med school at 30 kind of late or too late?

As you suggested this depends on the individual. Starting medical school at 30 would mean the earliest you would start residency is 34 and finish at 41. Residency in itself is a huge adjustment physiologically, taking call up to every 3rd night for years on end takes a toll on the body and mind. Having gone through the toughest part of residency (chief year aside), I know it certainly would have been that much harder to do because of this. While I am not saying it can or has not been done, the people who are selecting residents take this, albeit in a minor way, in to consideration.

 

[neusu]

Neusu...what was your MCAT score? Just Curious.

I got a 35Q (VR:11 PS:12 BS:12).

 

[neusu]

On average, how many chicks do you reel in per week? How do they react after you tell them your a neurosurgeon? How do you sift through the gold diggers? Thanks.

Contrary to contrary belief, most people do not know, nor do they care what brain, or neurosurgeons do. So, if you're going in to it for the chicks, I suppose there are other programs that are more glamorous.

 

[neurofan815]

Hi neuso,

This is such a wonderful thread to read through. Thank you so much for taking the time to give back to the SDN community! I have a couple of questions for you. I'm a freshman undergrad majoring in neuroscience. I definitely want to be a doctor (possibly a surgeon). I have recently taken a liking to neurosurgery as I had the opportunity to shadow a neurosurgeon in clinic for an extended period of time. Next semester, I'm going to shadow the same attending in the OR once per week. What advice can you give me as to making the most out of the experience? The attending seems willing to maybe let me help out on some research on epilepsy, but I don't want to push my luck. How do I manage to stay within that fine line between being interested and annoying?

On another note, merry Christmas! As far as working on holidays is concerned, is it a rotational system in which you work some holidays and not others or can you draw the smallest straw so to speak and have to work pretty much all of the major holidays in a year (Thanksgiving, New Year's, Easter, etc.)?

 

[neusu]

Just stumbled across this short article titled "Novice Neurosurgeons Train On Brains Printed in 3-D":

http://www.npr.org/blogs/health/201...-neurosurgeons-train-on-brains-printed-in-3-d

Is it really a novel idea? Do you or have you used anything similar in the past?

We're doing more and more unique things to teach doctors in training how to do what they need to do without putting the patient at risk. In my experience, these simulators and synthetic tissues do not feel like the same thing.

At my program, in any case, there is a graded responsibility commiserate with experience. That is to say, when you're an M3 you start by tying and cutting knots and by the time you're a PGY-7 you're dissecting the Sylvian Fissure and clipping aneurysms. Certainly there are numerous steps in between, but each step should be a learning opportunity which you can carry forward. One such example is performing a craniotomy. For patients with chronic subdural hematoma, there is essentially a cushion of blood between the skull and the brain. Learning to use the drill on a case like this where time is not a factor and there is a level of safety prepares you to do the craniotomy when there isn't that level of safety.

 

[neusu]

What do you think of CTFxC's youtube post "MAN FILMS OWN BRAIN SURGERY." If anyone hasn't seen it, this popular YouTube blogger has a brain tumor, and the surgeons let him film and vlog the whole thing. It also turns out it was malignant, and he's now vlogging his chemo process. He wants to encourage other people going through the same thing.

Would you let a popular YouTuber film your surgery and post it for millions to watch?

We typically use recordings during surgery for teaching purposes. For a wake craniotomy, certainly it would be possible for a patient to record his/her perspective or watch the surgery on a monitor. I would not be opposed to the patient recording the operation, but suspect there would be some institutional and privacy hurdles

 

[Akali]

Do you personally know any surgeons who are (video) gamers? Serious question

 

[Qwerty2013]

In your premed years, did you ever have a part time job in addition to other extracurriculars (like research, volunteering etc)? If so, what kind of job did you have?

 

[487806]

Glad to see this thread is still going strong after a year @neusu

Not sure if the question was asked before, but do you plan on working as an academic physician or in private practice?

 

[SLM914]

Hi,
I am very interested in Peripheral Nerve Surgery. I was looking into fellowships for this and was only able to find one at the Mayo Clinic. Can someone point me to a list of fellowships in peripheral nerve? Are there other ways to get to peripheral nerve specialty besides doing residency in neurosurgery? Plastics perhaps?
I would also appreciate any idea you could give me about the lifestyle of a Peripheral Nerve Surgeon as compared to other Neurosurgeons.

Thanks!

 

[neusu]

Hi neuso,

This is such a wonderful thread to read through. Thank you so much for taking the time to give back to the SDN community! I have a couple of questions for you. I'm a freshman undergrad majoring in neuroscience. I definitely want to be a doctor (possibly a surgeon). I have recently taken a liking to neurosurgery as I had the opportunity to shadow a neurosurgeon in clinic for an extended period of time. Next semester, I'm going to shadow the same attending in the OR once per week. What advice can you give me as to making the most out of the experience? The attending seems willing to maybe let me help out on some research on epilepsy, but I don't want to push my luck. How do I manage to stay within that fine line between being interested and annoying?

On another note, merry Christmas! As far as working on holidays is concerned, is it a rotational system in which you work some holidays and not others or can you draw the smallest straw so to speak and have to work pretty much all of the major holidays in a year (Thanksgiving, New Year's, Easter, etc.)?

Sounds like you are making the most of the experience already. Certainly, if a research opportunity opens, taking advantage of that would be beneficial.

Most programs will split the holidays so no one is on for every holiday. Generally the more junior residents share more of the work-load. Our 2nd year had part of Thanksgiving and Christmas time off but was on New Years. Typically at the beginning of the year, for us in any case, the chief will take requests (e.g. ask for it off if one holiday is more sentimental to you than others) and distribute accordingly. We also try to take in to account people's different religious holidays that may not be on the standard schedule.

 

[neusu]

Do you personally know any surgeons who are (video) gamers? Serious question

I can't say anyone I know is currently very in to gaming, but there certainly are people who were at some point in their life.

 

[justAstudent]

I can't say anyone I know is currently very in to gaming, but there certainly are people who were at some point in their life.

Makes me a little sad

 

[neusu]

In your premed years, did you ever have a part time job in addition to other extracurriculars (like research, volunteering etc)? If so, what kind of job did you have?

I sat at the front desk in the dorm some nights and officiated intramural athletic events. Pay wasn't great but the desk job was awesome I could sit and read for hours while getting paid. Officiating was nice because it made me go to the athletic complex a couple of days a week so I kept up with exercise. Otherwise, mostly just research and volunteering as an undergraduate.

 

[neusu]

Glad to see this thread is still going strong after a year @neusu

Not sure if the question was asked before, but do you plan on working as an academic physician or in private practice?

Thanks, me too! I didn't know if there would be an interest, but wanted to offer a channel for those who are interested to pose questions.

I am still undecided at the moment whether to pursue academics or private practice. I am feeling out fellowships and the job market. Only time will tell.

 

[roinom]

Is a strong interest in neuroscience important in order to become a good neurosurgeon? The specialty seems interesting in my opinion, however, I have not yet a big interest in neuroscience, rather I've enjoyed neuraoantomy and cellular neurobiology. The most interesting part for me seems to be vascular and tumor. I have talked to surgeons in other specialty, it doesn't seem like the urologist have a strong interest in the urinary system, rather they enjoy the surgery etcetc.

Of course there needs to be a interest, but some in my class in are just sold out on neuroscience and all the abstract fields such as higher cognition etc.

 

[eberb]

As a neurosurgery resident, do you need to pay for your own malpractice insurance?

 

[neusu]

Hi,
I am very interested in Peripheral Nerve Surgery. I was looking into fellowships for this and was only able to find one at the Mayo Clinic. Can someone point me to a list of fellowships in peripheral nerve? Are there other ways to get to peripheral nerve specialty besides doing residency in neurosurgery? Plastics perhaps?
I would also appreciate any idea you could give me about the lifestyle of a Peripheral Nerve Surgeon as compared to other Neurosurgeons.

Thanks!

To my knowledge, there is not a consolidated list of peripheral nerve fellowships. The AANS Fellowship directory (http://www.aans.org/Grants and Fellowships/Fellowship Directory.aspx) lists Mayo, Hopkins, and Calgary. I know LSU-NO formerly had a fellowship, but I believe Dr. Kline has semi-retired so it may no longer be available. Your best bet would be to browse the websites for neurosurgery programs and see who specializes in peripheral nerve and if they take fellows. Alternatively, as it is an interest of yours, you must keep abreast with the current literature. Look at the by-line for the article and see where the major studies are being conducted. Contact those individuals.

There are traditionally three paths to peripheral nerve: neurosurgery, plastic surgery, and orthopaedic surgery. The lifestyle for peripheral nerve surgeons is similar to most neurosurgeons. It is a very small field and requires a large referral to be solely a peripheral nerve surgeon. More than likely you'll have to be a general neurosurgeon with an interest in peripheral nerve until you establish yourself. With respect to Dr. Spinner at Mayo, he did residencies in both orthopaedics at Duke and neurosurgery at Mayo and a peripheral nerve fellowship at LSU.

 

[NorthernMav]

What are your thoughts on brain-machine interfaces?

 

[neusu]

Is a strong interest in neuroscience important in order to become a good neurosurgeon? The specialty seems interesting in my opinion, however, I have not yet a big interest in neuroscience, rather I've enjoyed neuraoantomy and cellular neurobiology. The most interesting part for me seems to be vascular and tumor. I have talked to surgeons in other specialty, it doesn't seem like the urologist have a strong interest in the urinary system, rather they enjoy the surgery etcetc.

Of course there needs to be a interest, but some in my class in are just sold out on neuroscience and all the abstract fields such as higher cognition etc.

A lot of people become interested in neurosurgery because of an interest in "neuroscience." However, a love for basic neuroscience is not required at all to become a good neurosurgeon. Certainly, a detailed understanding of how the nervous system works, goes bad, and what changes in a patient when it does is important. Likewise, how to evaluate, diagnose, and treat neurosurgical disorders is important. At the end of the day, neuroscience is a wide, diverse field. You mention vascular and tumor, those are both categories of neuroscience. Psychology, sociology, signal transduction, molecular pharmacology and electrophysiology all are parts of neuroscience. Find out what interests you and what does not, decide if you want to become a surgeon, and the decision becomes relatively easy.

 

[jram2323]

would yo

 

[neusu]

As a neurosurgery resident, do you need to pay for your own malpractice insurance?

Not directly. The malpractice insurance is paid by the GME and is typically covered by the money that Medicare gives the institution to train residents. Part of your taxes as a resident goes to fund Medicare, so you indirectly pay for part of your own malpractice insurance.

 

[Mt Kilimanjaro]

This might have already been asked, but can you estimate how many times a week you make a joke involving some derivation of the phrase "...this isn't brain surgery…"