Ask a neurosurgery resident anything

[neusu]

Do you like turtles?

Yes.

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[neusu]

What kind of class rank is impressive to report on your CV? Doesn't the class size also matter? If you're like rank 11 out of 150, does that stand out or is it better to leave it off the CV or just say top 10% of the class?

I'd generally not discriminate class rank in CV unless you are valedictorian (e.g. #1) or salutatorian (e.g. #2). Top 5, 10, 15, 25%, certainly, you could discriminate it. That being said, if you do, your CV is likewise otherwise weak. Work on things that are substantive to put on your CV, otherwise a 10-page CV seems like a lot of fluff.

 

[oceanmist]

1. "It's not just about scholarship. People don't realize the strenuous physical demands of the job. It's common to put in long hours in the OR, standing very still, performing delicate technical tasks with every ounce of dexterity you can muster. That takes stamina." In your opinion, how significant is this point in deciding whether or not to pursue NS? Can this type of stamina (to whatever degree it requires) be obtained over time during MS3 and residency?

2. "Certainly the upper echelons of the profession enjoy great status and wealth," agrees Dr. Louw, "but that's attainable faster and easier in other branches of medicine, and at far lower personal cost." Thoughts?

From http://www.salary.com/dream-job-brain-surgeon/

 

[The Buff OP]

Is it true most neurosurgery residents in their last year they start getting offers that will start at 700k a year?

 

[LostinLift]

What were some of your most useful (to you personally) study techniques in medical school?

What would you recommend to a future MS1 in regards to doing well in classes and preparing for the boards?

What do you wish (if anything) you would have done differently in medical school in terms of studying and also outside of studying?

 

[neusu]

1. "It's not just about scholarship. People don't realize the strenuous physical demands of the job. It's common to put in long hours in the OR, standing very still, performing delicate technical tasks with every ounce of dexterity you can muster. That takes stamina." In your opinion, how significant is this point in deciding whether or not to pursue NS? Can this type of stamina (to whatever degree it requires) be obtained over time during MS3 and residency?

2. "Certainly the upper echelons of the profession enjoy great status and wealth," agrees Dr. Louw, "but that's attainable faster and easier in other branches of medicine, and at far lower personal cost." Thoughts?

From http://www.salary.com/dream-job-brain-surgeon/

1) Neurosurgery is like most things in life wherein it has certain character traits which create a natural advantage when possessed. The two mentioned here, scholarship and stamina, are both things that can be developed over time. Flower's for Algenon aside, there realistically are limitations on increasing one's scholarship when significantly lacking at baseline. Likewise, going from ADHD to Zen Buddhism may be a stretch.

2) Status and wealth are relative concerns. When compared to the US national median income, or residents/medical students for that matter, any attending makes significantly more money and has a higher status. Within medicine as a whole there are plenty of other fields that fit the bill of quickly achieving status and wealth, even among attendings, even when compared to neurosurgeons.

 

[jram2323]

Can you compare the volume of spinal fracture/trauma as well as cranial blunt/trauma cases requiring neurosurgical intervention that you will see an attending at a larger hospital vs as a member of a private group practice?

 

[neusu]

Is it true most neurosurgery residents in their last year they start getting offers that will start at 700k a year?

Most people look for jobs starting their second to third to last year. Offers vary widely, but I have heard of offers north of that.

 

[neusu]

What were some of your most useful (to you personally) study techniques in medical school?

I read a lot, looked over my notes, copied things that I had trouble keeping straight. I'd try to meet with a study group periodically to just discuss and go over questions we had. I found it useful to hear about things others may stress that I ignored, but for the most part I just played funny youtube videos and jerked around and got uninvited for the next session.

What would you recommend to a future MS1 in regards to doing well in classes and preparing for the boards?

Do your best. Grades and step 1 matter a lot, but they aren't everything. Make sure your application is well rounded and patch over any gaping holes by overcompensating elsewhere. Studying more isn't always necessary, studying better might be the key.

What do you wish (if anything) you would have done differently in medical school in terms of studying and also outside of studying?

Can't say I really would change much leading up to where I am. I mean, I am where I want to be. I'm happy, healthy, and have great friends and memories from school.

 

[MelitensisIMG]

1) Try not to be too hokey, or simply recap your CV. In all honesty, I don't place much value in the personal statement
2) CV in its truest form is the most important part of the application. Publication record etc. is important, but expressing commitment to neurosurgery in particular is not a necessity. The CV helps to establish a track record of commitment to projects and success therein. It can be in GI or social sciences, but having experience developing an interest, researching, and publishing is important. That being said, if you initially started outside neurosurgery, having a transition towards neurosurgery is important. Likewise, a reason for this transition to discuss at the interview is important.
3) I'd rather not say for anonymity sake. It is a small field, you could easily find me knowing my position and alma mater.
4) This will be an issue. Even if you went to Oxford, not training in the US system creates a liability with respect to your medical knowledge base and clinical experience. Yes, doing well on Step-1 can offset the question mark regarding clinical knowledge. That being said, there are a multitude of IMGs who crush boards but just can not make the clinical connection on the wards. Likewise, clinical training abroad vastly differs from the US. Make sure you have a broad US clinical exposure, with letters, to verify you can successfully navigate the US medical environment.
5) So far as I'm concerned, Step-2 CK is the same as Step-3. Does not matter. That being said, if you bomb Step-1, take Step-2 early to show you can do well. Unfortunately, if you crush Step-1 and bomb Step-2, your advantage is lost.
6) The 4th letter would best be served as another academic US neurosurgeon. Make sure these neurosurgeons are either chairmen or titans (e.g. senior society members). There is no use getting a letter from someone who is an "academic neurosurgeon" who no one knows.
7) When asked during interviews, indicating your interest in pediatrics is acceptable. I would not recommend putting it in our personal statement. Much like medical school, residency is long and your mind on which sub-specialty to pursue (if any) changes

Excellent thread on a multitude of levels. Thanks for all the information and help @neusu . Further to point number 4) made by metasurgeon;

Being an IMG studying in a UK-system based university/hospital, I seem to be struggling to decide on the best way to approach this disadvantage. Our medical school will certainly not allow us to electively rotate in US-based hospitals during the scholastic months, so our only option is to do so in July, August or September. With most US hospitals requiring students to be in their final year for elective rotations, this allows for 3 one month electives only. I also feel that I do not have enough knowledge to commit to one speciality without having experienced it in the US (I assumed I would decide which residency suits me best after I experienced it in the elective rotation). These two premises have made me apply for two neurosurgery rotations and one neurology rotation. Do you think this puts me at a disadvantage with regards to securing a position in either field? Should I choose one speciality from now to obtain as much exposure (and consequently LOR's) in just one of the two fields?

 

[aj3834]

Thanks so much for this thread, Neusu. Current med school applicant here, would like to know more regarding your comment in bold below. Could you explain what is lacking in Harvard students that your attendings find in applicants from Hopkins? It does seem that Hopkins NS, at least, self-selects from their own medical students and, while there doesn't seem to be many HMS grads among residents at Hopkins, I would greatly appreciate your opinions on how the two are evaluated so differently, seeing as how both are top schools. Thanks!

Happy to help.

I hate to say it, but it matters which medical school you went to. My attendings drool over medical students from top school. Harvard, not so much. Hopkins, Columbia, UCSF, oh yeah. Our SubIs get preference in the match, unless the mess up. Top schools make a difference. Top letters from not top schools also make a reference. I won't out anyone, but there was a guy last year who had a HUGE board score, rotated at top programs, had INSANE letterers. While I can't say for certain, he matched where he wanted to.

 

[Perzt]

I have a question about manual dexterity. I posted a similar question in the surgery forum*. Some surgeons say the one thing you should have as a surgeon is a steady hand, some broaden this view to include also good psychomotor skills, good clinical judgement etc. It feels that "you shall have steady hands" is a kind of lazy way of reasoning. If one read the literature on this subject, it seems that hand tremor plays a very minor role in comparison to psychomotor skill, learning to handle tissue etc. I even read study saying that tremor was not correlated with adverse outcomes in microsurgery (wtf??), rather the ability to have a kind of tactile sense of what one is actually doing to the tissue was way more important. Also, tremor was not associated with longer time in the OR.

Is this "You must have steady hands to become a surgeon!" something surgeons say because they want to believe they're 100% stable? In my post in the surgery forum you can see a very famous plastic surgeon performing rhinoplasty and he is shaking pretty significantly.

Also, there must be some disctinction between for example postural tremor (shouldn't be all that common during surgery I guess) and intention tremor?

This seems to be kind of a hot topic, if you google "tremor+surgery+sdn" or something similar there are 20+ threads discussion this issue and I can see many medical students wondering. I would like to hear your input

* http://forums.studentdoctor.net/thr...al-skill-can-be-attributed-to-tremor.1057721/

 

[KingCaesar]

What do you like to listen to during a long surgery?

 

[docterjew]

Is neurosurgery more demanding intellectually the most other residencies? Have you seen residents that were okay with the physical demands of the program but could just not keep up with the academic portion? Is there a system in place to help these residents, or do they eventually just get fired if they do not improve enough?

Thanks for doing this!

 

[ReadyToRumble]

When I review applications for residency it goes thusly: Board score (near average +/- ?), letters (I know most letter writers, what they write, what they subtly mean), publications (journal, authorship, field, #). Then comes the interview.

Are extracurricular activities like community service or leadership expected/desirable on residency applications or at this level, as opposed to screening for medical school, has it been established that you care about people and want to help others?

It's clear that much value is placed on research, but I haven't heard any discussion about being involved in student run clinics, volunteering at local high schools to promote science, medical translating, leader of a club, etc. being a tremendously important thing to do in medical school. I'm interested in some of these but I also recognize that there is limited time. If a neurosurgery residency is the ulimate goal and NS could care less about these activities, then while that doesn't mean one shouldn't do them perhaps it does mean they should be given a different time priority than other aspects of medical school.

Thanks neusu, great thread!

 

[neusu]

Can you compare the volume of spinal fracture/trauma as well as cranial blunt/trauma cases requiring neurosurgical intervention that you will see an attending at a larger hospital vs as a member of a private group practice?

While I'm not an attending at a private group, nor a larger hospital, I can try to take a stab at the question.


Large academic centers are more or less affiliated with trauma centers. The amount of trauma at each institution varies significantly as well i.e. places that funnel all trauma in to one institution (such as Maryland Shock Trauma or Miami) see a high volume whereas places that divide it, or are just less populated/violent (Boston or Mayo) are significantly less busy. Attending call structure varies significantly from institution to institution and some have dedicated trauma attendings. Most programs are at hospitals which also have orthopedics so spine call is divided in some capacity. The vast majority of spinal/cranial trauma is non-operative.


Private practice also has a wide array of how they deal with trauma. Some are very similar to academic centers while others simply refuse to cover trauma call.

 

[neusu]

Excellent thread on a multitude of levels. Thanks for all the information and help @neusu . Further to point number 4) made by metasurgeon;

Being an IMG studying in a UK-system based university/hospital, I seem to be struggling to decide on the best way to approach this disadvantage. Our medical school will certainly not allow us to electively rotate in US-based hospitals during the scholastic months, so our only option is to do so in July, August or September. With most US hospitals requiring students to be in their final year for elective rotations, this allows for 3 one month electives only. I also feel that I do not have enough knowledge to commit to one speciality without having experienced it in the US (I assumed I would decide which residency suits me best after I experienced it in the elective rotation). These two premises have made me apply for two neurosurgery rotations and one neurology rotation. Do you think this puts me at a disadvantage with regards to securing a position in either field? Should I choose one speciality from now to obtain as much exposure (and consequently LOR's) in just one of the two fields?

Have you had rotations in either neurology or neurosurgery at our institution? This often helps to push you one way or another, prior to committing to a sub-internship.

Two rotations in neurosurgery should be sufficient to obtain enough letters and experience to support your application. Three would be better. With respect to difficulty matching and/or obtaining a sub-internship, neurosurgery is far more competitive. Thus, switching course from neurosurgery to neurology would likely better prepare you than the opposite.

 

[MelitensisIMG]

Have you had rotations in either neurology or neurosurgery at our institution? This often helps to push you one way or another, prior to committing to a sub-internship.

Two rotations in neurosurgery should be sufficient to obtain enough letters and experience to support your application. Three would be better. With respect to difficulty matching and/or obtaining a sub-internship, neurosurgery is far more competitive. Thus, switching course from neurosurgery to neurology would likely better prepare you than the opposite.

Thanks for the reply!

Did you mean my institution? I have rotated in both at my university but I still feel I should experience them in a US healthcare based setting before committing to one specialty. As you know, US and UK healthcare systems differ in several aspects, many of which may be limiting factors in my decision.
As for your suggested plan: I agree completely. Switching from neurosurgery to neurology will be far less challenging so I'll probably go for that approach.

Regards,
B

 

[The Buff OP]

@neusu Do you ever think neurosurgery residency will ever be cut short to like 5 years and do you think the neurosurgery residency should be shorter or 6-7 years is fine?

 

[neusu]

Thanks so much for this thread, Neusu. Current med school applicant here, would like to know more regarding your comment in bold below - I have strong reasons to be interested in neurosurgery, am fortunate to have been accepted to Harvard and Hopkins, and am trying to decide which to attend while considering my interest in NS and later possible application to NS residency. Could you explain what is lacking in Harvard students that your attendings find in applicants from Hopkins? It does seem that Hopkins NS, at least, self-selects from their own medical students and, while there doesn't seem to be many HMS grads among residents at Hopkins, I would greatly appreciate your opinions on how the two are evaluated so differently, seeing as how both are top schools. Thanks!

Congratulations on your acceptances.

I can't quite put my finger on it. The 3rd year setup at Harvard is a little peculiar in that there are multiple great hospitals affiliated with the school rather than the traditional single hospital. Comparatively, at least in my experience, the Hopkins candidates tend to be a bit more driven and a bit less entitled, but all med students anymore, for whatever reason, are becoming increasingly entitled. You can't go wrong at either school, but I suspect of the two Hopkins would have the edge, at the moment, for those interested in going in to neurosurgery.

 

[neusu]

I have a question about manual dexterity. I posted a similar question in the surgery forum*. Some surgeons say the one thing you should have as a surgeon is a steady hand, some broaden this view to include also good psychomotor skills, good clinical judgement etc. It feels that "you shall have steady hands" is a kind of lazy way of reasoning. If one read the literature on this subject, it seems that hand tremor plays a very minor role in comparison to psychomotor skill, learning to handle tissue etc. I even read study saying that tremor was not correlated with adverse outcomes in microsurgery (wtf??), rather the ability to have a kind of tactile sense of what one is actually doing to the tissue was way more important. Also, tremor was not associated with longer time in the OR.

Is this "You must have steady hands to become a surgeon!" something surgeons say because they want to believe they're 100% stable? In my post in the surgery forum you can see a very famous plastic surgeon performing rhinoplasty and he is shaking pretty significantly.

Also, there must be some disctinction between for example postural tremor (shouldn't be all that common during surgery I guess) and intention tremor?

This seems to be kind of a hot topic, if you google "tremor+surgery+sdn" or something similar there are 20+ threads discussion this issue and I can see many medical students wondering. I would like to hear your input

* http://forums.studentdoctor.net/thr...al-skill-can-be-attributed-to-tremor.1057721/

Everyone has a tremor, it is unavoidable. Those with more severe tremors who are in surgery have to learn to compensate for or control their tremor. While psychomotor skills are important, the decision behind which set of skills to be utilized is more important. I don't know what the other surgeons in the world say, but we in neurosurgery tend to say that you can teach any monkey how to operate, knowing what to do and when to do it, is what is important.

 

[neusu]

What do you like to listen to during a long surgery?

This depends on my mood and can change throughout the case. I like a variety of things including classic rock, alternative, jazz, lounge, house, hip hop, and classical. Under the microscope for a difficult case though I'll typically prefer to cut the music and lessen other distracting noises like suction or the saturation tone. The attending often gets final say.

 

[neusu]

Is neurosurgery more demanding intellectually the most other residencies? Have you seen residents that were okay with the physical demands of the program but could just not keep up with the academic portion? Is there a system in place to help these residents, or do they eventually just get fired if they do not improve enough?

Thanks for doing this!

I have not done many other residencies, so I am unqualified to comment on whether it is more intellectually or physically demanding than other fields. There certainly are residents who seem to have a knack for things and those who struggle. Different programs handle resident issues differently. Most programs, at least from what I have been told, make an attempt to rehabilitate, re-mediate, and or reinforce things residents are struggling to grasp. Residents do get fired, and there is a process for it that is usually laid out explicitly in the house-officer manual and departmental policies.

 

[neusu]

Are extracurricular activities like community service or leadership expected/desirable on residency applications or at this level, as opposed to screening for medical school, has it been established that you care about people and want to help others?

It's clear that much value is placed on research, but I haven't heard any discussion about being involved in student run clinics, volunteering at local high schools to promote science, medical translating, leader of a club, etc. being a tremendously important thing to do in medical school. I'm interested in some of these but I also recognize that there is limited time. If a neurosurgery residency is the ulimate goal and NS could care less about these activities, then while that doesn't mean one shouldn't do them perhaps it does mean they should be given a different time priority than other aspects of medical school.

Thanks neusu, great thread!

Yes, involvement in extracurriculars is important. Many neurosurgery residents have considerable personal achievements and passions in life outside of medicine (e.g. climbing Mount Everest, concert musician, nationally/internationally competitive athlete). Do what you enjoy in life.

That being said, too many high schoolers, undergrads, or med students naively believe that extracurriculars will make up for lack of fundamentals. Nothing you can do will compensate for low board scores, poor grades, bad letters, or lack of research.

You may be the nicest, most altruistic, loving, smartest person in the world, but you have to show me in 20 minutes. The best way to make sure that 20-minutes counts is to have a CV chocked to the brim with stuff we can concretely weigh (scores/grades) and interesting/admirable personal attributes (extracurriculars).

Finally, the contrary does not hold up. If you are only books/research and no extracurriculars, there is no penalty.

 

[tvelocity514]

Hi Neusu.

I'm an incoming M1 this fall with an interest in NSGY but had a quick technical question. I'm worried about how you can tell if your hands shake too much or not to be a neurosurgeon. It's not like I have tremors or anything - but they do shake a small amount (they just aren't strictly not moving if I hold them in the air). My sister is a med student and said there are beta blockers if I'm super worried about it like Indural (helps with performance anxiety/tremors) if I think it is really that bad... but I was curious about how you ascertained if you had steady enough hands for NSGY? Any thoughts on this would be greatly appreciated. Thanks!

 

[neusu]

Thanks for the reply!

Did you mean my institution? I have rotated in both at my university but I still feel I should experience them in a US healthcare based setting before committing to one specialty. As you know, US and UK healthcare systems differ in several aspects, many of which may be limiting factors in my decision.
As for your suggested plan: I agree completely. Switching from neurosurgery to neurology will be far less challenging so I'll probably go for that approach.

Regards,
B

I did mean at your institution. True, there are differences between training in the US and the UK. Despite this, you should have a feel, globally, if you are more drawn towards neurosurgery or neurology.

Let me know how things go

 

[Boolean]

If there was one piece of advice you could give to an undergrad interested in neurosurg, what would it be?

 

[The Buff OP]

@neusu You probably forgot about it.

 

[neusu]

@neusu Do you ever think neurosurgery residency will ever be cut short to like 5 years and do you think the neurosurgery residency should be shorter or 6-7 years is fine?

This is a tough question. If neurosurgery shortened the research, elective, and on service clinical time it could be 5-years. This would likely require a fellowship for nearly most things aside from the absolute bread and butter (craniotomy for hematoma, non-instrumented spine, etc.). The ACGME is migrating to a core-curriculum model with competencies. At the moment there is no accelerated path, meaning if you hit all the milestones early you still wait it out for 7 years. That being said, they have addressed that in the future that there may need to be a mechanism for merit based expedited advancement, essentially saying "we'll get to it." As great as that sounds, it most certainly would be the exception and not the rule to have someone who is truly capable of advancing through all of the ACGME milestones early. Otherwise, the milestones would just be made more difficult.

@neusu You probably forgot about it.

Just hadn't gotten to it yet, sorry.

 

[Guero]

This is a tough question. If neurosurgery shortened the research, elective, and on service clinical time it could be 5-years. This would likely require a fellowship for nearly most things aside from the absolute bread and butter (craniotomy for hematoma, non-instrumented spine, etc.). The ACGME is migrating to a core-curriculum model with competencies. At the moment there is no accelerated path, meaning if you hit all the milestones early you still wait it out for 7 years. That being said, they have addressed that in the future that there may need to be a mechanism for merit based expedited advancement, essentially saying "we'll get to it." As great as that sounds, it most certainly would be the exception and not the rule to have someone who is truly capable of advancing through all of the ACGME milestones early. Otherwise, the milestones would just be made more difficult.



Just hadn't gotten to it yet, sorry.

To add to this, I noticed that osteopathic NSGY residencies average 6 years as opposed to allopathic's 7. Just an interesting tidbit that might be off of the allopathic radar. You might want to double check that info, too, as I read it about two years ago. That might change as osteopathic and allopathic GMEs merge to accept both COMLEX and USMLE. There's no telling what all is about to change in that realm...

 

[neusu]

Hi Neusu.

I'm an incoming M1 this fall with an interest in NSGY but had a quick technical question. I'm worried about how you can tell if your hands shake too much or not to be a neurosurgeon. It's not like I have tremors or anything - but they do shake a small amount (they just aren't strictly not moving if I hold them in the air). My sister is a med student and said there are beta blockers if I'm super worried about it like Indural (helps with performance anxiety/tremors) if I think it is really that bad... but I was curious about how you ascertained if you had steady enough hands for NSGY? Any thoughts on this would be greatly appreciated. Thanks!

Try not to worry about a tremor. Some of the greatest surgeons have a noticeable tremor.

 

[Cyberdyne 101]

Sorry if this has been asked before.
Do you think more neurosurgeons will start treating pediatric/adolescent scoliosis? I'm interested in the overlap that neurons have with orthopods when it comes to the spine.

Also, how many myxopapillary ependymomas have you seen so far?

 

[neusu]

If there was one piece of advice you could give to an undergrad interested in neurosurg, what would it be?

Persistence is key

 

[altitudinarian]

Despite neurosurgery not having the best lifestyle options, does it still provide opportunities/foundation to do groundbreaking research in figuring out the workings of the brain and neuro-degenerative//neurological diseases and disorders? Or would it better just to do research and not pursue MD?

 

[Dr Turkelton]

How is the Neurosurgery program at University of Toronto regarded among american neurosurgeons? Would you place it in the same league as the top few american programs?

 

[mmmcdowe]

How is the Neurosurgery program at University of Toronto regarded among american neurosurgeons? Would you place it in the same league as the top few american programs?

I personally would consider it a top program. Their functional and pediatrics programs are off the wall.

 

[neusu]

Sorry if this has been asked before.
Do you think more neurosurgeons will start treating pediatric/adolescent scoliosis? I'm interested in the overlap that neurons have with orthopods when it comes to the spine.

Also, how many myxopapillary ependymomas have you seen so far?

Practice patterns evolve depending on individual surgeons interests. I personally have little interest in pediatric scoliosis, but there are neurosurgeons who are. Spine coverage between neuro and ortho depends on the hospital.

With respect to myxopapillary ependymoma, I'd have to check my case log but quite a few. It's considered a "rare disease" by the NIH, but at a referral center the rare cases come up more frequently.

 

[studentp0x]

Out of complete pointless curiosity, what sort of GPAs/MCAT scores do other neurosurgeons you may have talked to have (if it was ever mentioned)?

 

[medicalmnt]

How much studying do you do before a surgery?

Do you REALLY need steady hands?

What do you do to relax and calm down?

 

[neusu]

Despite neurosurgery not having the best lifestyle options, does it still provide opportunities/foundation to do groundbreaking research in figuring out the workings of the brain and neuro-degenerative//neurological diseases and disorders? Or would it better just to do research and not pursue MD?

Neurosurgery research is very diverse. While not many neurosurgeons are able to have a robust clinical practice and conduct ground-breaking research concomitantly, it is possible. Likewise, we are the only people who are able to truly take a study translational, from bench to bedside. There are some PhD type folks who think of us as mere technicians e.g. put this probe there for me, or inject this vector. Just as well, there are some surgeons who are happy to serve that role. More often though, we want to conduct the research and then take it to the patients themselves.

 

[altitudinarian]

Neurosurgery research is very diverse. While not many neurosurgeons are able to have a robust clinical practice and conduct ground-breaking research concomitantly, it is possible. Likewise, we are the only people who are able to truly take a study translational, from bench to bedside. There are some PhD type folks who think of us as mere technicians e.g. put this probe there for me, or inject this vector. Just as well, there are some surgeons who are happy to serve that role. More often though, we want to conduct the research and then take it to the patients themselves.

Thank you for this answer! In realizing that there are other specialties I can go into, I wanted to make sure that I wasn't being too conceited/narrow-minded in my dedicated interest in neurosurgery.

 

[tiedyeddog]

Hey Neusu, I have three neurosurgery sub-I's coming up in a few short months. Any tips for impressing as a Sub-I? One of the chiefs at my home program said impressing the residents is more about making sure orders on the floor are carried out, and helping the interns, and less about performance during surgeries, as SubIs don't get to do much during surgery.

Or any advice on books/resources a Sub-I should have? The handbook of neurosurgery is a given, anything else I should get?

 

[neusu]

How is the Neurosurgery program at University of Toronto regarded among american neurosurgeons? Would you place it in the same league as the top few american programs?

Toronto is certainly by far and away the best Canadian program. I'd put their peds and functional programs in the top tier. Overall, though, they'd likely be Tier one in the US, behind the "elites."

 

[neusu]

Out of complete pointless curiosity, what sort of GPAs/MCAT scores do other neurosurgeons you may have talked to have (if it was ever mentioned)?

This is highly variable. Everybody has a different path to their career. There are neurosurgeons who started at community college. There are neurosurgeons who had less than stellar GPAs in high school, college, and medical school. There are neurosurgeons who bombed the SAT/ACT, MCAT, or USMLE. Is this the norm? Not at all. The majority have a record of excellence. For what its worth, once you're in med school, no one cares about SAT let alone MCAT. Once you're in residency, no one cares about MCAT let alone USMLE. The NBME board exam is a pass/fail. So long as you can perform, no one cares if you failed out of high school, took the MCAT 14 times, went to the Caribbean and transferred to a DO school (sorry for the blatant stereotypes, not intending to offend, but to make a point). That being said, convincing a program to give you a shot, I would not advise that path.

 

[mentalhypoxia]

Hi neusu,

Thanks for starting this thread! I'm not sure if this has been asked before, but how would a "summer remediation" or repeating MS1 due to a failed class look when applying to residencies? I'm at an east-coast school known for putting students into neurosurgery (we had 3 this year) and everyone has the same mantra: Step 1, LOR, research, fantastic AI's, so I was wondering how badly a remediation/repeat year would hurt.

 

[neusu]

How much studying do you do before a surgery?

Do you REALLY need steady hands?

What do you do to relax and calm down?

For each surgery we review the images. Depending on the complexity it varies. For an average spine surgery it can be a cursory review of the anatomy. For a complex aneurysm, it can be hours of looking at angiograms and 3D reconstructions.

Steady hands are nice but not requried.

I tend to exercise to relax and calm down. A nice cup of tea helps too.

 

[neusu]

Hey Neusu, I have three neurosurgery sub-I's coming up in a few short months. Any tips for impressing as a Sub-I? One of the chiefs at my home program said impressing the residents is more about making sure orders on the floor are carried out, and helping the interns, and less about performance during surgeries, as SubIs don't get to do much during surgery.

Or any advice on books/resources a Sub-I should have? The handbook of neurosurgery is a given, anything else I should get?

I always like this question.

The 3 A's of surgery: "available, affable, and able." Always be there. Always put on a good affect. Practice things that you should be able to do so when given the opportunity you shine (and always be willing to learn new things). It is hard to learn about something or how to do something by experiencing it if you're at home. No one wants to work with someone who is a jerk or always in a bad mood. While not being able to do a lot in the OR is expected, not knowing how to do simple things is a red-flag.

True, carrying out the orders, checking on things such as labs/vitals orders etc. is important. Try to see what the Jr resident does and try to be able to do it first (if appropriate). Yes, being scutted out sucks. Yes, it can be educational. As a 3rd year being asked to grab ice for an abg or taking something the lab or pick something up from the pharmacy seems uneducational. As an intern who didn't know you can/should do that, you look like a *****. Know how to suture things like skin (simple interrupted, burried SubQ interrupted, running SubQ) and tie knots (2-hand, 1-hand, instrument tie).

Get a Greenberg, know the basics in there on management of common things (tbi, aneurysms, carotids, post-op crani's, pituitaries, spine, spinal cord injury). Learn the numbers of common things cold. Having done a rotation at home in neurosurgery and or ICU helps. Always read about the case you're going to go to so you know the anatomy and general proceedings from incision to closure.

Feel free to PM me if you have other questions or need more specific advice.

 

[Cyberdyne 101]

Is endoscopy the future of neurosurgery?
And if so, will that make your life easier and better for patients?

 

[neusu]

Hi neusu,

Thanks for starting this thread! I'm not sure if this has been asked before, but how would a "summer remediation" or repeating MS1 due to a failed class look when applying to residencies? I'm at an east-coast school known for putting students into neurosurgery (we had 3 this year) and everyone has the same mantra: Step 1, LOR, research, fantastic AI's, so I was wondering how badly a remediation/repeat year would hurt.

These things are bad. A single course, often you can get away with. Repeating an entire year, you will need a significant explanation for why you needed to repeat. Just as there are gold tickets to neurosurgery (the aforementioned Crushing Step 1, killer LORs, loads of great research, nailing SubIs) there are red flags (failing a course(s), repeating years, conduct disorders, institutional action).

I don't mean to put it this way, because this always offended me, but here's an analogy: You walk in to a stereo/car/clothes store and look around, everything seems to fit right in your mind and the sales people are friendly and helpful. Then it comes down to the price, if you have to ask the price: you can't afford it. If you have to ask "can I become a neurosurgeon with a felony conviction and failed year," you likely can't. That being said, absolutely, people consistently prove this wrong. Work hard, figure out what you messed up in, overcompensate and fix it!.

 

[orangeman25]

Just wanted to post a Thank You for doing this!