Ask a neurosurgery resident anything

[Guero]

Any thoughts on Dr. Saleem I. Abdulrauf's recent proposal on a paradigm shift in NS training? http://hosted.verticalresponse.com/1165029/664d849dea/544430237/1c8aa3eedf/ It'd allow for those wishing to focus on a more generalist and acute practice to complete their residencies in 5 years, while those wishing to pursue more academic, research, or specialized practices to complete theirs in 7.

Ahem, there is more than one nsg resident on this forum

So, any thoughts while I have your attention? I'm very curious to hear others' opinions on this issue.

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[tiedyeddog]

So, any thoughts while I have your attention? I'm very curious to hear others' opinions on this issue.

The lack of support from organized neurosurgery in the US (AANS, SNS) demonstrates how most US trained/practicing neurosurgeons, especially academic, feel about this proposal.

 

[mmmcdowe]

Just spoke to the head of the RCC of SNS. They feel no need to do this because we already are recruiting from the best group of medical students, "so who are we trying to recruit with this?"

 

[jram2323]

what are your thoughts on pediatric neurosurgery?

Are the joys of working with cute little kids often overshadowed by complications/ bad outcomes?

 

[neusu]

Wowee! You guys seemed to have a new kindled interest in this thread, and I'm happy to have some help from any others in the field!

If we could set some new ground rules.

General questions can continue as it is and I'll continue to answer them in the order in which they are posted, as I have been thus far.

If someone else who is a neurosurgery resident or attending comments on your posting I'll skip it over and reply with "see xxx post." If I have anything to add I will, but I suspect my colleagues will be able to be more prompt than I currently am.

If you have a question specifically for me, do as some others have, and put the @neusu in the post so it's flagged that I am tagged. When I read it I'll reply specifically. If anyone else feels compelled to answer in the interim, please do so.

Thanks for the great feedback everyone. Tbh, I am surprised we haven't had any trolls roll through, at least that I can recall!

 

[neusu]

Amazing to see this thread still going strong after 2.5 years...

Sorry if my question is out of place in this thread or if I just seem ignorant, but I am starting PT school in a couple of months and am very interested in neurorehabilitation. I'm curious if surgery and rehab ever come in much contact with each other. In the time I have spent around neuro PTs my perception was that the collaboration/consultation on the medical specialty side of things was primarily with PM&R docs. Do neurosurgeons and PTs ever encounter each other or do surgeons spend any time around the rehab unit? I guess I'm curious what the transition is generally like for the patient going from neurosurgery to rehab.

This is somewhat surgeon dependent. We interact with therapists on a daily basis for our patients in the hospital. Part of our discharge process is to have them work with and evaluated by different therapists (depending on what is appropriate: speech pathology, physical, occupational, etc). When we discharge patients to the various places they go (rehab, subacute rehab/skilled nursing, nursing, long-term acute care, hospice, home with services, home) we often cut them loose. Some surgeons I have worked with will visit patients in their various settings to keep abreast of their progress. This is on top of regular clinic appointments. That being said, neither I have to admit, neither I, nor the docs I work with are rehab doctors. I can speak to the doctor in charge (as you mentioned PM&R) as to my thoughts and goals, but he'll obviously know much more about their techniques, programs, and goals. My goal as the neurosurgeon is simply to protect as much brain and spinal cord I can while the patient is at risk, stabilize any other medical issues that arise during this treatment, and get them to the recovery experts.

 

[neusu]

Hello!
As mentioned numerous times before, your willingness to post here is invaluable in helping others decide if neurosurgery is the path for them or not, and answer some interesting questions about NS in general. Here's my question(s) to you as an aspiring Neurosurgeon: Currently, i am a High School Senior and am graduating in the top 10% of my class with an International Baccalaureate diploma on top of my regular high school diploma, my HS GPA is a 3.81 out of 4 and my ACT was a 34/36. Im a Georgia resident so i applied to University of Georgia and Emory and have been accepted to both and am currently committed to Emory because i applied via Early Decision II Which is binding, however i also applied to Johns Hopkins back in November for ED I but was deferred unfortunately. Being that Hopkins is my dream school, I have already committed to Emory and i wholeheartedly believe that Emory is a good school and although i havent declared my major, i applied as a neuroscience and behavioural biology major so there will be a spot for me there so to speak. First off, i know you're not a college admissions officer but do you think it would be worth my while to attempt a transfer to Hopkins? I am just wondering if having an undergraduate degree from JHU Vs. Emory is really considered all that much in the admissions process for Med School, i imagine it would be on down the list but i felt like it would be worth asking.

Secondly, what can i do as an undergraduate to best help my chances of getting into a top notch Medical school, i know the givens such as high MCAT scores but was wondering if study abroad would help me at all as i will have the opportunity to study at Oxford or Cambridge for a semester as well.

When/How did you prepare for the MCAT?

How did you spend your undergrad years outside of the classroom?

I believe that is all for now, but i will continue to follow this thread!

I get a lot of PMs from HS students or calls from family friends about what they should have their kids do.

Universally, I tell them to live their life how they want it lived. As I'm sure you can tell from college admissions, with your stellar stats, there isn't a cookbook to this. Both Emory and Hopkins are exceptional schools, you'll do well to have graduated from either. I wouldn't worry about transferring unless you truly want to be somewhere else, or you'd prefer to have another name brand on your education. The foreign school experience, if available to you, is something I always recommend. Not only having that on your transcript is great, but also the experience being out of your element. Likewise, volunteering abroad be it the Caribbean, Africa, or Southeast Asia can change your view on life.

Certainly, if you want to be a neurosurgeon, and you're somewhat sure already as a HS student, look more in to it. It is a fantastic field and I love it, I want everyone to love it. That being said, it really isn't for everybody. Setting your goals high will never let you down. Say you want a top 5 med school and could easily get it, the likelihood of being able to switch that to a top B-school or law school is high. Do your best, broaden your horizons. Med school applications are just as harsh as undergrad, if not more. Volunteer, shadow, do research, cure AIDS/cancer/herpes.

You mentioned MCAT and grades. That's 90% of the battle. Much like dating, getting the date is the hard part. Winning them over is the rest. Have things med schools want. I'm not saying take up esoteric hobbies or do something you never wanted to, but point out the things you already excel at. I had people in my class who picked a different undergraduate specifically so they'd be a NCAA D1 athlete on their med school applications.

Finally, and this is what I tell all of the medical students I work with personally or who contact me interested in multiple surgical fields and unable to decide. Look at the job you're interested in. After all, it is just a job. After you get over the excitement. After you get over the "it's a privilege to cut someone's chest/spine/heart/abdomen/brain open." After you get over the I'll be a doctor so x thoughts. At the end of the day, do you want to be responsible for another human's life at a whim? You had plans but it's your patient? Your coverage doesn't know the complexities of this case..

I make no claims to be superhuman, but often I feel as if I have to be to do this job. Perhaps that is what attracted me to it initially, and perhaps that is what attracts you now. I make no claims to be pious, but I am..

 

[titanmoon]

This is such a great thread! Thank you neusu for all your time and the great info you shared with us. I have a few more questions hope you don't mind answering:
1) you mentioned in an earlier thread that for matching into NS residency the med school does matter, that JHU, Columbia, UCSF are some of the top schools(or at least I think that's what you meant), but then you also mentioned in other places that one should go to the cheapest school one can get into, which for most people would mean their state school, wouldn't that put them at a disadvantage for residency matching into NS ?
2) Have you heard anything about Univ. of Washington in terms of its med school quality and how well its grads match into NS?
3) what would you consider are the top 10 or 15 med schools for those interested in NS ?
4) does research in Alzheimer's help in getting into NS or is that more Neurology? Do you know of many NS who treat patients with Alzheimer's or do research in that area?

 

[manofmen]

hello there! thank you for creating this forum.

this is for whomever may be able to answer. i'm really interested in global health and was wondering what the scope is like for neurosurgeons? are there any that do it, and what is it like? i saw on the msf website that they don't want neurosurgeons, so i was curious about the scope of the field with regards to global health. thank you!

 

[mmmcdowe]

hello there! thank you for creating this forum.

this is for whomever may be able to answer. i'm really interested in global health and was wondering what the scope is like for neurosurgeons? are there any that do it, and what is it like? i saw on the msf website that they don't want neurosurgeons, so i was curious about the scope of the field with regards to global health. thank you!

http://www.uwhealth.org/about-uwhea...eurosurgery-skills-to-hospital-in-kenya/15033

http://medicine.umich.edu/dept/neurosurgery/projectshunt

http://doctorqmd.com/what-we-do/mission-work/
Some of the most important people in neurosurgery do international work, most prominently in peds I suppose.

 

[mmmcdowe]

This is such a great thread! Thank you neusu for all your time and the great info you shared with us. I have a few more questions hope you don't mind answering:
1) you mentioned in an earlier thread that for matching into NS residency the med school does matter, that JHU, Columbia, UCSF are some of the top schools(or at least I think that's what you meant), but then you also mentioned in other places that one should go to the cheapest school one can get into, which for most people would mean their state school, wouldn't that put them at a disadvantage for residency matching into NS ?
2) Have you heard anything about Univ. of Washington in terms of its med school quality and how well its grads match into NS?
3) what would you consider are the top 10 or 15 med schools for those interested in NS ?
4) does research in Alzheimer's help in getting into NS or is that more Neurology? Do you know of many NS who treat patients with Alzheimer's or do research in that area?

1) Go where you are happy. Who you are is more improtant than where you went with the exception of a few highly inbred institutions.
2) Great school, look at the match list if you want to see where they match
3) The 10-15 that make you happiest and most productive, but that answer probably won't satisfy you. Programs known for producing a lot of applicants include Columbia, Indiana, Hopkins (recently), UVA, USC, and UMNDJ off the top of my head.
My chairman is a big Alzheimer's guy, but yeah it is mostly Neurology. That being said, a fair shair of great applicants, particularly MD PhDs, have put Alzheimer's research as their primary investigational activity and have done fine. http://www.neurosurgery.pitt.edu/person/robert-friedlander

 

[neusu]

I've never shadowed surgery before, but I'm shadowing a neurosurgeon soon. Can I go pee during a long surgery? What's the etiquette of leaving the OR in the middle of the surgery?

Great question!

I never knew when I was a med student so I assumed it was a faux pas to leave. I figured leaving was seen as a sign of weakness so I decided I wouldn't show it. Fast forward to my first year out of med school. I'm scrubbed in assisting in an epic spine case and about 8 hours in to the 14-hour saga I have to go pee. Generally on morning rounds I'll have a coffee or something. In any case, when the final stitch was thrown and the drapes were drown I was running knock-kneed to the bathroom. Ever since that case I've had an OCD response to scrubbing in to a case, no matter what I have to void prior to scrubbing.

I tell this story because I was stupid and worried about machismo. No one cares. Now, I'll scrub out and go if I need to. Just be cognizant of the case you are in and try to make it tactful.

 

[titanmoon]

Thanks mmmcdowe!

Another question: do most neurosurgeons match straight into neurosurgery out of med school? Can someone match into another specialty first, such as emergency medicine, general surgery or internal medicine, then go into neurosurgery when he is done with that other residency? Would that prolong the 7 year residency? Also, do most residents tend to stay at the same hospital or state to practice once they finish their residency?

 

[mmmcdowe]

Thanks mmmcdowe!

Another question: do most neurosurgeons match straight into neurosurgery out of med school? Can someone match into another specialty first, such as emergency medicine, general surgery or internal medicine, then go into neurosurgery when he is done with that other residency? Would that prolong the 7 year residency? Also, do most residents tend to stay at the same hospital or state to practice once they finish their residency?

It is very difficult to match expect by applying directly to neurosurgery. It is definitely possible, but your options are diminished rather than improved. If you apply for the match you are applying for an intern spot no matter what your background is. Sometimes you can get a pgy2 position outside of the match if youve done an internship, but this is case by case. Every now and then a senior position opens up and a appropriately trained neurosurgery resident can slide in. I would guess that the highest proportion of residents congregate in the home area, but that it is not a huge fraction, just more than the average state (i.e. more than 100% divided by fifty states, adjusted to the variable number of practices in a given state) This tilt is at least partially because some number will stay on as attendings.

 

[neusu]

have you come to terms with the long term damage you are doing to your body due to lack of regular and adequate sleep?

What damage do you speak of?

That being said, yes I've come to terms with the fact that my career path involves sacrifice, both seen and unseen.

 

[NeuroOsler]

Hi @neusu thanks again for this awesome thread.

For those of us that are applying this year, do you have any general advice? Anything to work on in the last few months (not counting sub-i, do well etc.)

Thanks!

 

[titanmoon]

It is very difficult to match expect by applying directly to neurosurgery. It is definitely possible, but your options are diminished rather than improved. If you apply for the match you are applying for an intern spot no matter what your background is. Sometimes you can get a pgy2 position outside of the match if youve done an internship, but this is case by case. Every now and then a senior position opens up and a appropriately trained neurosurgery resident can slide in. I would guess that the highest proportion of residents congregate in the home area, but that it is not a huge fraction, just more than the average state (i.e. more than 100% divided by fifty states, adjusted to the variable number of practices in a given state) This tilt is at least partially because some number will stay on as attendings.

I'm a bit confused. What is the difference between internship and residency? When I was browsing through those "match lists" for different med schools, I often see "Neurosurgery" with a couple of training hospitals under -- are these seniors going into internships rather than residencies? If you can't match straight into neurosurgery, how do most people become neurosurgeons?

 

[mmmcdowe]

I'm a bit confused. What is the difference between internship and residency? When I was browsing through those "match lists" for different med schools, I often see "Neurosurgery" with a couple of training hospitals under -- are these seniors going into internships rather than residencies? If you can't match straight into neurosurgery, how do most people become neurosurgeons?

Neurosurgery residency has an infolded internship. Unlike some specialties where you do an internship in another specialty or even hospital, you do both internship and residency in neurosurgery at the program that you match at. Thus, neurosurgery internship is part of residency. The point is if you apply for a neurosurgery position through the Match, you will have to start as an intern (PGY1) in neurosurgery even if you are an attending in another specialty.

 

[CTU Surgeon]

Thanks @neusu !

Two Questions:

1) I will be starting medical school in the fall and already have a wife and an 8 month old. While people tell me that this is likely to change often during medical school, neurosurgery interests me more than any other field within medicine. However, I have a bit of hesitation about the field because of the demanding schedule that is required. Do you or some of your colleagues have your own families and is it possible to have something of a work/life balance? I imagine that I would have a lot less time to be with family during my formal training but have more control and time after training, depending on the job I land. Does this sound correct?

2) I'm bouncing back and forth between attending school at Penn or Duke. They will both cost about the same and I think that my family and I would be happy at either. If I'm very interested in neurosurgery, would you recommend either program above the other?

Thanks for your time and help!

 

[neusu]

Any thoughts on Dr. Saleem I. Abdulrauf's recent proposal on a paradigm shift in NS training? http://hosted.verticalresponse.com/1165029/664d849dea/544430237/1c8aa3eedf/ It'd allow for those wishing to focus on a more generalist and acute practice to complete their residencies in 5 years, while those wishing to pursue more academic, research, or specialized practices to complete theirs in 7.

The general feeling of organized neurosurgery is that the WEDNS is a rogue society and not to be taken seriously.

Certainly, there can be some efficiencies created in the current training model. The proposal listed is not fundamentally different than the current process in place by the ABNS. Perhaps there is something more there that I am missing, but I am at a loss as to why someone would feel compelled to create an entire new training system that replicates the current system.

 

[Eokpar02]

Hello!
As mentioned numerous times before, your willingness to post here is invaluable in helping others decide if neurosurgery is the path for them or not, and answer some interesting questions about NS in general. Here's my question(s) to you as an aspiring Neurosurgeon: Currently, i am a High School Senior and am graduating in the top 10% of my class with an International Baccalaureate diploma on top of my regular high school diploma, my HS GPA is a 3.81 out of 4 and my ACT was a 34/36. Im a Georgia resident so i applied to University of Georgia and Emory and have been accepted to both and am currently committed to Emory because i applied via Early Decision II Which is binding, however i also applied to Johns Hopkins back in November for ED I but was deferred unfortunately. Being that Hopkins is my dream school, I have already committed to Emory and i wholeheartedly believe that Emory is a good school and although i havent declared my major, i applied as a neuroscience and behavioural biology major so there will be a spot for me there so to speak. First off, i know you're not a college admissions officer but do you think it would be worth my while to attempt a transfer to Hopkins? I am just wondering if having an undergraduate degree from JHU Vs. Emory is really considered all that much in the admissions process for Med School, i imagine it would be on down the list but i felt like it would be worth asking.

Secondly, what can i do as an undergraduate to best help my chances of getting into a top notch Medical school, i know the givens such as high MCAT scores but was wondering if study abroad would help me at all as i will have the opportunity to study at Oxford or Cambridge for a semester as well.

When/How did you prepare for the MCAT?

How did you spend your undergrad years outside of the classroom?

I believe that is all for now, but i will continue to follow this thread!

No one cares where you go to college. No one cares what you studied in college. The only thing of any significance is your GPA and MCAT.

 

[deleted421268]

Any advice and tips for an undergraduate for getting into med school? Studying and extracurriculars.

 

[Guero]

The general feeling of organized neurosurgery is that the WEDNS is a rogue society and not to be taken seriously.

Certainly, there can be some efficiencies created in the current training model. The proposal listed is not fundamentally different than the current process in place by the ABNS. Perhaps there is something more there that I am missing, but I am at a loss as to why someone would feel compelled to create an entire new training system that replicates the current system.

Muy interesante. I had no idea the ABNS was already mid-way through a similar update. Must've been because my face has been plastered in organ systems' books. LoL

Thanks as always, @neusu.

 

[neusu]

Well, for example I have a friend working on improving a prosthetic leg for people who have their entire femur removed because the technology hasn't been improved upon recently and those who have to use this prosthetic leg still have to use a crutch to get around because the leg can't fully support their weight. What are the devices that you have the most complaints about maybe? Or just what is one of the biggest problems you come across? I think it would be really great if I could implement something so relevant to my future aspirations to my honors thesis!! Even just one or two ideas would really help and would be greatly appreciated! Thank you so much

Tough to say. We only really implant spine hardware and deep brain or nerve stimulators. If you could improve the battery life or programming of the sitmulators that would be helpful.

 

[addy]

Asked this in the Allo thread but I'll cross post here bc I'm curious what neusu has to say, too--

MS2, going into MS3 here.

I love neurosurgery, especially functional/DBS stuff. However, the thought of doing spine work sounds like hell, with the exception of spinal oncology stuff. What would you say to a person like me who has a relatively narrow interest given that spine work makes up such a big part of a neurosurgeon's work.

My problem is is that I have small areas of interest in a lot of fields, most notably CT surg, peds CT surg and neurosurgery. I don't know if I'm kidding myself if I think I can make a career out of those niches given that my step was only 0.5 st dev over mean and my path in academic Xsurgery will likely be an uphill battle coming from a 'low tier' school...

 

[Surgeon's Cuffs]

Hi Neusu,

Im wondering what your opinion is on the outlook for regenerative medicine in neurosurgery. Kind of an abstract thought I guess, but I have interest in both and want to see if its doable. Thanks again!

 

[neusu]

Have you ever performed/assisted/observed a craniosynostosis? I think that is a bad*** procedure!

Also, were you gifted in other areas of life prior to neuro? Did you have a specific talent that honed your hand-eye coordination?

Would you ever have the time or energy to hit the gym for one hour a day?

Do you ever wake up and say, "Wow, I'm a neurosurgeon."?

Have you ever unintentionally realized a person you know might have a serious neurological condition (maybe they have a weird tic, tremor, idk)?

What kind of humor do you have (dry, perverted, or your one of the ones who don't find things funny, maybe)?

I'd apologize for the numerousness of questions but you know you want to answer them

I have been involved with craniosynostosis. They can be life saving and/or improving cases. While I am not particularly fond of pediatric cases, I did enjoy these.

I do try to get to the gym when I can. Usually an hour or so at a time, several times per week.

Every now and again I do have the epiphany that I am indeed a neurosurgeon.

I have inadvertently diagnoses friends or relatives. Likewise, I have had friends and relatives relay their complaints to me and, based on what they say, have an idea of what the issue is be it a disc herniation, stenosis, brain tumor, or MS.

I am rather dry with my humor.

No worries about the questions. Keep them coming.

 

[Neutropix]

@neusu

How do you feel about surgeons recording their cases on Snapchat, e.g., "Dr. Miami." Would you ever strap a go pro on your body and record a procedure?

When operating an intermediate to advanced case, what do you find more difficult: the physical aspects of operating, like hand movement and applying pressure, or just memorizing each step of the procedure and the anatomy? That is, is it more intellectually difficult or technically, hands on difficult?

Also, when operating, do you ever achieve "flow states" also known as being in the zone?

Thanks again,

signed ignorant pre med

 

[Guero]

. . .

I am rather dry with my humor.

. . .

My mind immediately went to this:
[YouTube]THNPmhBl-8I[/YouTube]

 

[vh12655]

Hello neusu (and the other residents who have begun to post on this thread),

When asked about how you handle sleep deprivation during residency, you responded by saying that making this transition was not too much of an issue for you since you are naturally able to function well on 4-6 hours of sleep per night (please correct me if I am paraphrasing this statement incorrectly). Was this an ability you have always had, or was it acquired as you became older? Have you observed how other residents who function optimally on the average 7-9 hours of sleep per night are able to adjust to the demands of residency, or would you say that having the ability to function well on 4-6 hours of sleep is a prerequisite to not only completing a residency in neurosurgery, but in surgery in general? If the other residents posting on this thread could share some of their experiences surrounding this topic as well it would be greatly appreciated.

Thank you for your time, this thread has greatly helped to unveil many of the questions I had surrounding your field.

 

[ridethecliche]

Do you even lift?

Gotta love ortho. Lol.

 

[neusu]

Do you have siblings? If so have they also pursued very challenging careers? How often are you able to see your family?

I do have siblings. They have excelled in their chosen fields, but, from my neusu-centric world view they haven't bit off quite as much. They are happy, and doing well, however, and that is really all that matters.

EDIT: Oop, forgot the 2nd half the question..

I see them at increasingly infrequent intervals. Something about life catching up with everybody results in less time to share.

 

[neusu]

Hi @neusu , I have a quick question. For preclinical grades, is having virtually all honors a must or is earning high passes acceptable as well? I ask because I am an incoming MS1 and deciding between a school that restricts honors to the top 10% of the class versus another school that doesn't have this restriction. I'm concerned that if I'm unable to make the 10% cutoff then I won't be able to be a competitive candidate for neurosurgery. To match into neurosurgery, do you typically have to be in the top 10% of your class anyways? Thank you for the thread. It's been very informative.

I tend to try to think of things in logical arguments. Is earning all honors a MUST? No, not at all. Does it help? Absolutely. Do you HAVE to be in the top 10% of your class? No. Does it help? Yes.

All other things being equal, go to the school at which you think you will do the best. If that is the > 90 %ile gets honors, then go there and aim high. If it's the other school, then go there. At the end of the day, the education you get is the most important factor. You can honor everything and still fail Step 1, or you can scrape by in your schools grading system and have the highest score in the country. Part of the reason there are standardized tests is to create a yardstick for everybody to be measured on the same scale. Every school in the country has a different curriculum, grading scale, and intra-class difficulty that makes it very difficult to discern objectively from isolated individuals' transcripts how they compare to someone else at a different school. Incidentally, USMLE was never intended to be a quantitative exam to stratify students, but instead a qualitative "will this doctor know enough medicine to practice." Ensuring you learn the most during school sets you up to do well on Step 1, succeed on your 3rd and 4th year rotations, do well in residency, and your career.

That being said, follow the recipe for success (good grades, good scores, good reccs, good research, good extra-curriculars, no red flags) and you LIKELY won't go wrong.

 

[neusu]

@neusu I've been hearing a lot about how the new hours may be leading to less well-trained surgeons; I read an article from an attending saying those in fellowship were less able to do complicate surgeries independently compared to previous years. What's your take on it?

Since neurosurgery has 7+ years of residency are they doing more surgeries than other residents?

Thank you so much for doing this thread. I've been reading for a while and decided to post.

Tough to tell. The 80-hour graduates have only just started practice, it'd be best to have a good number of years outcome data to compare pre- and post- rule. That being said, there are surgeons who will be great and those who will struggle, no matter the amount of training.

The average neurosurgery graduate has 1,000-1,500 cases logged. I am not sure what the numbers are for other surgical subspecialities, but I wouldn't be surprised if it were higher given that a lap-chole or hernia repair can take 30 min whereas most neurosurgery procedures are 1-3 or significantly longer than 3 hours.

 

[The Buff OP]

@neusu Look at you, you're a moderator now.

Just stopping by, broham. You are on your last year of residency, right?

 

[FictiousForce]

What are the specific physically exhaustive parts of neurosurgery?

How long are the surgeries and what is the variance? How long is a typical workday/workweek for an attending and a resident?

 

[neusu]

Any advice for interns about to start in ~3 months?

Haha a little late on the up-take on this one now that I'm a couple of months behind!

For the next 3 months, take it as easy as you can. This will be the last time for the next 3-7+ years (or entire life) that you will be able to have an extended period of free time. See family, travel, enjoy life.

Once the ball drops and internship starts, just do what you've been doing all along: do well. Work hard, read, try to relate to your patients (even the undesirable ones), and be nice. Running around the hospital or clinic like a stressed out maniac does not make many friends, or allies rather, among your peers, the nursing staff, your attendings, or patients for that matter. Finally, no matter how bad you think you have it, how entitled you are to chew someone else out because you have it so much worse than they do, don't. There is always someone else there who has it worse than you.

 

[neusu]

AOA?

American Osteopathic Association










jk
Alpha Omega Alpha. The medical honor society, elected in the junior and senior years of medical school.

 

[Guero]

@neusu or @mmmcdowe have either of you ever assessed a conscious pt for spinal shock via the bulbocavernosus exam? If so, how the HECK does one explain it to the pt, especially a woman?

While at another school, a junior resident instructed the visiting M4 I was with to conduct the exam on a conscious trauma pt; but rectal tone was already present on routine DRE, negating the need for the more thorough exam. I've yet to see someone explain that exam to a pt, but feel like it'll probably always be on an unresponsive pt, or at least one with AMS. But if not, I'd like to get an idea of how to best explain it to pts... Thanks as always.

 

[mmmcdowe]

@neusu or @mmmcdowe have either of you ever assessed a conscious pt for spinal shock via the bulbocavernosus exam? If so, how the HECK does one explain it to the pt, especially a woman?

While at another school, a junior resident instructed the visiting M4 I was with to conduct the exam on a conscious trauma pt; but rectal tone was already present on routine DRE, negating the need for the more thorough exam. I've yet to see someone explain that exam to a pt, but feel like it'll probably always be on an unresponsive pt, or at least one with AMS. But if not, I'd like to get an idea of how to best explain it to pts... Thanks as always.

I have never tested the bulbocavernosus. I have done rectals and a few cremasters in various situations.

 

[neusu]

So what about the "top 10" programs, then?

This is a subjective thing. As mentioned, however, programs routinely regarded as top have specialist attendings who are renowned in each subspeciality, often multiple, as well as a strong research base.

 

[neusu]

Neusu - i am very interested in the science behind the brain. Would a BS in neuroscience assist in anyway for a student interested in neurosurgery?

A BS in neuroscience will help you understand better the "science behind the brain." Will it make you a better neurosurgeon? Likely not. The two are very different things. Indeed, neurosurgeons have to have an in depth understanding of the brain, the anatomy, physiology, how things interact on various levels. That being said, we approach it from different perspectives.

 

[neusu]

what are your thoughts on pediatric neurosurgery?

Are the joys of working with cute little kids often overshadowed by complications/ bad outcomes?

To put it mildly, we don't often see healthy cute little kids. Most of the kids we deal with are premature needing a ventriculostomy->shunt, myelo needing repair-> shunt, shunt revision, craniosynostosis/MR/CP/congenital disease, child related trauma, or non-accidental trauma. The latter can be very hard. That being said, I do like the kids because they tend to be very scared but very trusting if you can gain their trust.

 

[Guero]

To put it mildly, we don't often see healthy cute little kids. Most of the kids we deal with are premature needing a ventriculostomy->shunt, myelo needing repair-> shunt, shunt revision, craniosynostosis/MR/CP/congenital disease, child related trauma, or non-accidental trauma. The latter can be very hard. That being said, I do like the kids because they tend to be very scared but very trusting if you can gain their trust.

Sounds familiar, every time we were paged to Children's that night from my previous post, it was for a shunt or someone p/w complication s/p shunt. Thankfully no trauma that night. Not looking forward to my peds core, as our hospitals compete for the some of the nation's top violent trauma volume.

 

[neusu]

This is such a great thread! Thank you neusu for all your time and the great info you shared with us. I have a few more questions hope you don't mind answering:
1) you mentioned in an earlier thread that for matching into NS residency the med school does matter, that JHU, Columbia, UCSF are some of the top schools(or at least I think that's what you meant), but then you also mentioned in other places that one should go to the cheapest school one can get into, which for most people would mean their state school, wouldn't that put them at a disadvantage for residency matching into NS ?
2) Have you heard anything about Univ. of Washington in terms of its med school quality and how well its grads match into NS?
3) what would you consider are the top 10 or 15 med schools for those interested in NS ?
4) does research in Alzheimer's help in getting into NS or is that more Neurology? Do you know of many NS who treat patients with Alzheimer's or do research in that area?

1) It certainly is a difficult balance to strike. First and foremost, go somewhere with a neurosurgery program. Second, go to the best fitting, cheapest, most "prestigious" school you can.
2) Great for both
3) Could you clarify your criteria? Top schools for # matched in to neurosurgery, highest %age of applicants matching, places to live for those wanting to go in to neurosurgery, etc.
4) Alzheimer's tends to be more on the neurology side of things. There are clinical trials under way for placement of DBS for Alzheimer's, however, which is neurosurgery.

 

[neusu]

Hi @neusu thanks again for this awesome thread.

For those of us that are applying this year, do you have any general advice? Anything to work on in the last few months (not counting sub-i, do well etc.)

Thanks!

If you don't have any publications/research as of yet it's not too late to get a case-report. Not counting Sub-Is, just learn as much general medicine as you can. Being the best all-around doctor you can will be the best thing you can do for your patients.

 

[neusu]

I'm a bit confused. What is the difference between internship and residency? When I was browsing through those "match lists" for different med schools, I often see "Neurosurgery" with a couple of training hospitals under -- are these seniors going into internships rather than residencies? If you can't match straight into neurosurgery, how do most people become neurosurgeons?

All neurosurgery programs are 7 years in length and integrated, meaning the PGY-1 year is part of the neurosurgery program. Could you point out a specific example for schools that list multiple training hospitals? For instance, people who match at Harvard can be either at MGH or at Children's/Brigham & Women's. Many programs have their residents at multiple sites, perhaps the school lists each hospital?

 

[neusu]

Thanks @neusu !

Two Questions:

1) I will be starting medical school in the fall and already have a wife and an 8 month old. While people tell me that this is likely to change often during medical school, neurosurgery interests me more than any other field within medicine. However, I have a bit of hesitation about the field because of the demanding schedule that is required. Do you or some of your colleagues have your own families and is it possible to have something of a work/life balance? I imagine that I would have a lot less time to be with family during my formal training but have more control and time after training, depending on the job I land. Does this sound correct?

2) I'm bouncing back and forth between attending school at Penn or Duke. They will both cost about the same and I think that my family and I would be happy at either. If I'm very interested in neurosurgery, would you recommend either program above the other?

Thanks for your time and help!

1) Certainly during training, you will have to sacrifice family time for work. Residency and family life aren't mutually exclusive, but a surgical sub-specialty residency is a very jealous lover. Simply the number of hours required and inflexibility of the schedule can make things difficult. Being up front with your partner about the requirements of you at work, and the help you will need at home makes a huge difference.

2) They are both exceptional choices for school. Personally, I would say Penn given there are 3 programs in Philly, perhaps you could work with another program as well and have 2-home progams to some degree. I'm more of a city guy anyway so I'd rather live in Philadelphia than Durham.

 

[neusu]

Do you even lift?

New PR erryday. Anything for the gainz

 

[neusu]

Any advice and tips for an undergraduate for getting into med school? Studying and extracurriculars.

Study what interests you and what you do well at. Hate biology, love French literature? Don't be a bio major! Sure, take the prereq, but no need to go bananas. The more unique and interesting your extracirriculars can be, without being to weird, the better. Likewise, the better you are at a hobby or sport, the better it looks.