Ask a neurosurgery resident anything

[Guero]

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@neusu What is your opinion on backboards and C-collars? Are they even necessary? There hasn't been any actual prove that C-collars and backboards actually help immobilizing the spine.

Also, PS4 or Xbox One?

Some of my colleagues and I were arguing this topic from an EM perspective a while back. After some digging, I remember that we found some institution that was in the process of designing a RCT to investigate efficacy of C-collar in trauma. We were surprised considering the ethical implications. But I never heard anything more. For anyone that has time, a quick lit review might turn something up now if they were able to get IRB approval...

 

[jram2323]

Question regarding research between M1 and M2: I'm interested in gen surg, neurosurgery and also ortho. I'd be happy doing research in any of the 3, although I know it helps one's application if one does it in the field he/she plans on going into. What would you recommend for me in this situation? I'm afraid I may commit to a project in a field that's unrelated to my chosen specialty. Thank you for your help!

 

[neusu]

Bottom line, how hard is it to get any residency in neurosurgery? Assuming preference due to regional bias, how competitive are the people matching at Upstate, Buffalo, NYMC, Albany, LIJ, Tufts, Temple, UMDNJ, etc, etc, etc? 240s Step 1 with 2-3 pubs? More? Less?

Bottom line, it is very hard. While I am not at any of the aforementioned programs, I did interview at several of them. The sense I get, across the board, is that the reported average (e.g. Step 1 240, 2-3 pubs etc) is pretty universal at all programs. There, naturally, is some variance around the mean, but my impression is that it is corrected for by compensating other factors (e.g. Step 1 230 has more pubs, in higher impact journals and so forth).

 

[Serous Demilune]

Bottom line, it is very hard. While I am not at any of the aforementioned programs, I did interview at several of them. The sense I get, across the board, is that the reported average (e.g. Step 1 240, 2-3 pubs etc) is pretty universal at all programs. There, naturally, is some variance around the mean, but my impression is that it is corrected for by compensating other factors (e.g. Step 1 230 has more pubs, in higher impact journals and so forth).

Thanks!

 

[neusu]

@neusu What is your opinion on backboards and C-collars? Are they even necessary? There hasn't been any actual prove that C-collars and backboards actually help immobilizing the spine.

Also, PS4 or Xbox One?

Backboards and c-collars are important until a spine injury has been ruled out. Maintaining a neutral spine during transportation can be difficult and these external immobilizers help with that. The last thing we want after a spine injury is for the injury to worsen, or perhaps cause a previously absent neurological deficit.

PS4life!

 

[Blue Blood]

@neusu
1) When you say get involved early, should I just cold email the residency director (or someone with a lab) summer before MS1 to get something going? How receptive are neurosurgeons to these emails coming out of the blue?
2) Many programs have research after junior years, do you feel that this allows clinical skills to atrophy some? (I realize some programs require call coverage during this time)
Thanks!

 

[neusu]

Question regarding research between M1 and M2: I'm interested in gen surg, neurosurgery and also ortho. I'd be happy doing research in any of the 3, although I know it helps one's application if one does it in the field he/she plans on going into. What would you recommend for me in this situation? I'm afraid I may commit to a project in a field that's unrelated to my chosen specialty. Thank you for your help!

True, research in any field is better than no research at all. Picking an overlap between fields can help to hedge e.g. spine research covers ortho and neuro or carotid vascular covers neuro and general (vascular subsp). If you truly have no preference at this point it can be tough. Look at the departments at your institution and see which has the most opportunity for research. Try and join a group that is productive, so that you get something to show for your time. Finally, aim high. Ortho and neuro are more competitive than general, aiming for either and being a strong candidate would likely position you to go to any of the 3 while falling short would still keep you competitive for general. Aiming for general and being a strong candidate may not be sufficient for ortho/neuro, and being a weak general candidate puts all 3 at jeopardy.

 

[emflem]

True, research in any field is better than no research at all. Picking an overlap between fields can help to hedge e.g. spine research covers ortho and neuro or carotid vascular covers neuro and general (vascular subsp). If you truly have no preference at this point it can be tough. Look at the departments are your institution and see which has the most opportunity for research. Try and join a group that is productive, so that you get something to show for your time. Finally, aim high. Ortho and neuro are more competitive than general, aiming for either and being a strong candidate would likely position you to go to any of the 3 while falling short would still keep you competitive for general. Aiming for general and being a strong candidate may not be sufficient for ortho/neuro, and being a weak general candidate puts all 3 at jeopardy.

What is the intellectual joy you get out of surgery? I assume there's the technical mastery and accomplishment, but the way you write about it makes it seem like you get something deeper from it. Is there anything you can compare it to? This is what I'm most curious about.

 

[neusu]

@neusu
1) When you say get involved early, should I just cold email the residency director (or someone with a lab) summer before MS1 to get something going? How receptive are neurosurgeons to these emails coming out of the blue?
2) Many programs have research after junior years, do you feel that this allows clinical skills to atrophy some? (I realize some programs require call coverage during this time)
Thanks!

1) This certainly is an option. Most programs have a coordinator that you could contact and ask whom is doing research you could ask to participate in. Also, seeing if you can shadow in clinic, or things of a similar nature, allows for you to get to know the surgeons and look for opportunities to help with clinical projects.

2) Yes and no. Certainly, coming back to the OR after a long period away, you can feel rusty. A lot of surgery is biomechanical/tactile and muscle memory. It is very much like riding a bike. Learning the techniques and anatomy is the difficult part in the first place. Remembering after a period away is not terribly difficult. Finally, many programs have limited operative experience for junior residents, thus there aren't many skills to atrophy in the first place.

 

[neusu]

I started reading this and couldn't stop. It's amazing how well you express things. I knew by page 3 I would easily let you operate on my brain (if you can find it). Thank you so much for sharing so much. Any tips on developing good bedside manner like it seems you have?

This may be like asking a conductor what he gets out of music, but what is the intellectual joy you get out of surgery? I assume there's the technical mastery and accomplishment, but the way you write about it makes it seem like you get something deeper from it. Is there anything you can compare it to? This is what I'm most curious about.

As a totally separate question, are you friends with any plastic and reconstructive surgeons? If so, what sort of differences do you see between neuro and plastics? I ask since that's another super competitive one and you addressed ortho and there was the "you can't hide a dollar from a plastics guy" joke.

As a final real question, how important is decisiveness in a (neuro)surgeon? Is slow and methodical OK, or do you have to get in and get out as fast as possible? What's your style?

Has this thread ever come up when you were reviewing applicants? With anyone you accepted? Did you fess up?

Is there anything we can do for you to repay you for such an amazing thread? Besides a tremendous thank you and not asking the same lame questions over and over by kids who are too important to read the whole thing? I kinda wish we knew where you were so we could buy a beer (or ten if you're off for a few days).

Thanks. I have had a bit of fun with this thread and it's nice to hear that someone gets something out of it.

Bedside manner is something that takes time to develop. When you are on your rotations, both on rounds seeing patients and in the operating room with surgeons, try to pay attention to individuals you feel are better at what they do than others. Be it a technical ability or procedural smoothness in the OR or way with words and empathy at the bedside, some surgeons have a knack with what they do. Your role as a student is to learn yourself the practice of medicine, and I always found it useful to identify role models to emulate, as well as bad examples to avoid their pitfalls. In all honesty, I tended to spazz out when I speak to patients (or other doctors for that matter), so I actively slowed down my delivery and was able to better choose my words. This allowed me to be direct, poignant, and use their reaction to what I've said thus far in saying what I'd like to say so I do not steam roll their feelings.

You are absolutely right. There is a deeper appreciation for surgery than a simple technical mastery of movements. Performing surgery is a combination of intellectual and mechanical understanding of human anatomy and physiology. Every day can be testing of both, and thus physically and mentally exhausting. Despite this, if your efforts prevail, the patient benefits from your labor. It is somewhat miraculous that we can incapacitate someone for a transient period with anesthesia, cut them open, and cut out parts or replace/repair others and they go back to their lives. I can't quite describe the feeling, but your right, there is some of the feeling of success I have gotten playing an instrument well after practicing, a milestone in exercising, or getting a grade back after a big test. Now imagine that on a daily basis, but that it directly effects another human and their family.

I am friends with many of the plastics people. They are pretty great. We do cranial vault remodeling together as well as craniofacial cases.

I am sure many will disagree with me, but methodical is really the only safe way to practice surgery. What I mean, is have a plan, have a back-up plan, have a fail-safe, worst case plan. In my, albeit limited, experience, many of the surgeons who are in and out fast as possible, cut corners and lack technical ability to perform elegant surgeries quickly. In doing so, they tend to make mistakes that end up taking longer than if they had just plodded through the surgery in the first place. My style is to perform the best surgery I can in every case that I am involved with. I look for efficiency. I have found that being prepared, anticipating and avoiding pitfalls as well as having a solution ready should they arise, keeps things moving along. So, am I methodical? Yes. Am I slow? No.

I have had heard medical students mention this thread to one another, but no one has specifically asked me if I am the author.

 

[proc0408]

I have an interest in a variety of surgical specialties. However, I am currently looking at trauma and neuro. In your opinion, what field do you feel has the better "lifestyle", compensation, training, job stability, job stability, variety of cases, and complexity of cases? Also would it be possible to go as a trauma surgeon and then become certified to take on trauma cases that deal with neuro or cardio (primarily neuro)? If so how does compare to straight neurosurgery in the questions I asked above?

 

[neusu]

I have an interest in a variety of surgical specialties. However, I am currently looking at trauma and neuro. In your opinion, what field do you feel has the better "lifestyle", compensation, training, job stability, job stability, variety of cases, and complexity of cases? Also would it be possible to go as a trauma surgeon and then become certified to take on trauma cases that deal with neuro or cardio (primarily neuro)? If so how does compare to straight neurosurgery in the questions I asked above?

From what I gather, neurosurgery has a better lifestyle than trauma surgery. Neurosurgery call as an attending tends to be from home whereas trauma call, at least at busy centers, remains in-house. Neurosurgeons tend to be better compensated than trauma surgeons. The former is 7-years while the latter is 5 (+/- 2 years of research) + 1-2 years of trauma/critical care fellowship. In some cases, the trauma/critical care fellowship can be conducted enfolded, though I am not clear on the particulars therein. With respect to the variety and complexity of cases, neurosurgery again has the nod. Straight out of residency, a general neurosurgeon does a wide range of cases from brain to spine, trauma to tumors. Trauma surgeons, in my experience, function as the traditional trauma surgeon e.g. the guy who takes someone to the OR for an ex-lap, but also manages patients admitted to the trauma service in the trauma ICU and possibly floor (e.g. non-operative, or interventional radiology, management). Further, in order to increase case numbers, they often function as more of an acute-care surgeon e.g. appy/chole for patients who need it urgently. Perhaps it is my bias, and I am sure I will get flamed by the general surgeons, but I tend to think of trauma surgeons (as well as general surgeons) as getting boxed out of the rest of the body. Essentially, bones are ortho, blood vessels vascular, GU/kidneys uro, eyes ophtho, head/neck PRS, heart cardiac, lungs thoracic, and brains/spine neuro. That leaves the gut. Take this dividing the territory a step further with colorectal doing colon/rectum and hepatobilliary doing liver/pancreas. That leaves small bowel, appendix, gallbladder, spleen and stomach. Many of the elective cases are being carved out by the MIS fellowship trained people who don't take trauma call. That being said, in the middle of the night with a sick patient, there really are no boundaries and trauma surgeons crack chests etc. I can't say I have ever heard of a trauma surgeon being certified to take on neuro trauma cases. They certainly do manage a fair number of our patients with other organ systems injured, but they do not operate on the nerous system. The only exception I have ever heard of would be placement of burr holes to temporize a hemorrhage at a center without neurosurgeons, and even that I haven't heard of a concrete case just rumors that it has, or could have, happened.

 

[proc0408]

From what I gather, neurosurgery has a better lifestyle than trauma surgery. Neurosurgery call as an attending tends to be from home whereas trauma call, at least at busy centers, remains in-house. Neurosurgeons tend to be better compensated than trauma surgeons. The former is 7-years while the latter is 5 (+/- 2 years of research) + 1-2 years of trauma/critical care fellowship. In some cases, the trauma/critical care fellowship can be conducted enfolded, though I am not clear on the particulars therein. With respect to the variety and complexity of cases, neurosurgery again has the nod. Straight out of residency, a general neurosurgeon does a wide range of cases from brain to spine, trauma to tumors. Trauma surgeons, in my experience, function as the traditional trauma surgeon e.g. the guy who takes someone to the OR for an ex-lap, but also manages patients admitted to the trauma service in the trauma ICU and possibly floor (e.g. non-operative, or interventional radiology, management). Further, in order to increase case numbers, they often function as more of an acute-care surgeon e.g. appy/chole for patients who need it urgently. Perhaps it is my bias, and I am sure I will get flamed by the general surgeons, but I tend to think of trauma surgeons (as well as general surgeons) as getting boxed out of the rest of the body. Essentially, bones are ortho, blood vessels vascular, GU/kidneys uro, eyes ophtho, head/neck PRS, heart cardiac, lungs thoracic, and brains/spine neuro. That leaves the gut. Take this dividing the territory a step further with colorectal doing colon/rectum and hepatobilliary doing liver/pancreas. That leaves small bowel, appendix, gallbladder, spleen and stomach. Many of the elective cases are being carved out by the MIS fellowship trained people who don't take trauma call. That being said, in the middle of the night with a sick patient, there really are no boundaries and trauma surgeons crack chests etc. I can't say I have ever heard of a trauma surgeon being certified to take on neuro trauma cases. They certainly do manage a fair number of our patients with other organ systems injured, but they do not operate on the nerous system. The only exception I have ever heard of would be placement of burr holes to temporize a hemorrhage at a center without neurosurgeons, and even that I haven't heard of a concrete case just rumors that it has, or could have, happened.

I truly appreciate your time and input!

 

[josephpx]

Shortest week you've ever had?

 

[proc0408]

I also have a question regarding how malpractice insurance work. Does the hospital cover it, I cover it, or is it a mixture? If it depends on specialty I would like you to answer in regards of neurosurgery.

 

[Merely]

It is so refreshing that you are arguably the hardest worker in the entire hospital yet you still make time to come back and consistently post in a college forum to help and inspire future generations. Thank you so much sir, you are a good person.

 

[neusu]

Shortest week you've ever had?

I don't really keep track, to be honest. Any week I'm off for vacation is pretty short at 0 hours. Weeks with holiday weekends that I'm off are short as well with only 4 days I'd be between 48 and 64 hours or so. Weeks with only a regular weekend are longer with 60-80. Regular weeks always push the limit. This is also contingent on call frequency that week/overall and if I'm on service, electives, or research. Infrequently, for off-service weeks, if I didn't have call, I'd only put in 35-40 hours of work.

 

[barsoum.michael]

When did you realize you wanted to be a neurosurgeon?

 

[neusu]

I also have a question regarding how malpractice insurance work. Does the hospital cover it, I cover it, or is it a mixture? If it depends on specialty I would like you to answer in regards of neurosurgery.

I'm still a resident, so my malpractice is covered by the GME through my hospital.

From what I can tell, in practice, malpractice coverage can be covered by different entities. People in independent private practice generally need their own coverage, or have it as part of their contract with their group. How much and what it covers varies as well. For private practice surgeons who are employed by the hospital, or a larger, multi-specialty group, it is almost universally covered by the hospital/group. This applies to those in academics as well.

Some states, for surgeons employed by the state university, or those employed by the federal government (e.g. VA or military) are covered by the organization and suits are limited/capped as well.

*edit - didn't mean to hit submit early

 

[neusu]

It is so refreshing that you are arguably the hardest worker in the entire hospital yet you still make time to come back and consistently post in a college forum to help and inspire future generations. Thank you so much sir, you are a good person.

Thanks! I am glad you guys find this of some use and are still interested after all this time. I didn't imagine this would make it past 1 page, let alone a year. It is encouraging to see so many people interested in considering neurosurgery, or at least interested in learning about what it is we do.

 

[neusu]

When did you realize you wanted to be a neurosurgeon?

I first thought about it as an undergraduate. I was pre-med and thinking about what in medicine I liked and neurosurgery certainly was high on that list. I knew for sure during medical school, both after doing research in my first 2-years and then during 3rd year rotations.

During residency, I realize how lucky I am to be able to do what I do, regularly. I'm sure the OR staff and my attendings are sick of me coming in to the OR after scrubbing and starting things off with "You know what, we really have the best job in the world!" Sounds cheesy, I know, but it's how I truly feel at the moment and want to share it with everyone in the room. Interestingly, after typing that there's a part of me that says, "what a tool!" In any case, try to be happy with what you do.

 

[ridethecliche]

@neusu , at my institution, ortho spine and neurosurg take turns for call.

 

[barsoum.michael]

I'm 17 and I shadowed a neurosurgeon during the summer. I really enjoyed it and can see myself doing it but people think I'm crazy for say that.

I first thought about it as an undergraduate. I was pre-med and thinking about what in medicine I liked and neurosurgery certainly was high on that list. I knew for sure during medical school, both after doing research in my first 2-years and then during 3rd year rotations.

During residency, I realize how lucky I am to be able to do what I do, regularly. I'm sure the OR staff and my attendings are sick of me coming in to the OR after scrubbing and starting things off with "You know what, we really have the best job in the world!" Sounds cheesy, I know, but it's how I truly feel at the moment and want to share it with everyone in the room. Interestingly, after typing that there's a part of me that says, "what a tool!" In any case, try to be happy with what you do.

 

[ridethecliche]

I'm 17 and I shadowed a neurosurgeon during the summer. I really enjoyed it and can see myself doing it but people think I'm crazy for say that.

Pretty much everyone that goes into medicine is a little crazy. You have to be in order to want to do something that takes so long and is so difficult when there are plenty of easier ways to have a more comfortable lifetime for people that are clearly smart.

People are going to tell you you're wasting your time by being interested in whatever you're interested in. Learn to ignore the nay-sayers and move on with your life and it'll work out well for you in the long run!

 

[barsoum.michael]

I agree with you a million percent. It's kind of disheartening when people I know in medical school don't even think it's worth it

Pretty much everyone that goes into medicine is a little crazy. You have to be in order to want to do something that takes so long and is so difficult when there are plenty of easier ways to have a more comfortable lifetime for people that are clearly smart.

People are going to tell you you're wasting your time by being interested in whatever you're interested in. Learn to ignore the nay-sayers and move on with your life and it'll work out well for you in the long run!

 

[neusu]

@neusu , at my institution, ortho spine and neurosurg take turns for call.

This is pretty standard. Both specialties are spine surgeons and, if a training program is involved, require exposure to the field. For what it's worth, most of my friends, at least the ones not interested in doing spine, would be happy to forgo spine call entirely.

 

[THH]

Hey @neusu ,

A couple of questions for you.

1. Whats that breakdown between OR days/clinic days per week for most attending surgeons? 3 OR, 2 clinic days? Do you find clinic days intellectually stimulating or mostly just "filler" between OR days?

2. How much non-operative management does neurosurgery end up doing? At our hospital it seems like even IC bleeds are given to neurology if deemed inoperable by NSG.

Thanks! I've read most of the thread at some point but not completely sure if this has been asked before. Sorry if it has.

 

[jram2323]

As an attending, how many of your ~300 or so operations per year would you estimate ending up with the patient severly debilitated or even dead due to intra or post operative complications? Is it more in cerebrovascular?

 

[neusu]

I'm 17 and I shadowed a neurosurgeon during the summer. I really enjoyed it and can see myself doing it but people think I'm crazy for say that.

Hmm. Well I'm in my 30s and a neurosurgery resident and people say I'm crazy for doing it.

 

[barsoum.michael]

I never understand why people are so discouraging

Hmm. Well I'm in my 30s and a neurosurgery resident and people say I'm crazy for doing it.

 

[emflem]

I never understand why people are so discouraging

Easier to drag others down than lift yourself up.

 

[neusu]

Hey @neusu ,

A couple of questions for you.

1. Whats that breakdown between OR days/clinic days per week for most attending surgeons? 3 OR, 2 clinic days? Do you find clinic days intellectually stimulating or mostly just "filler" between OR days?

2. How much non-operative management does neurosurgery end up doing? At our hospital it seems like even IC bleeds are given to neurology if deemed inoperable by NSG.

Thanks! I've read most of the thread at some point but not completely sure if this has been asked before. Sorry if it has.

1)) At the moment, we do 1 half day of clinic per week. Most attendings do 2-3 days of clinic from what I can tell. I used to hate clinic, but now I am starting to appreciate it. In fact, some PCPs are referring their patients to me for some reason lol.

2) We do a lot of non surgical management. Certainly for trauma. At my institution, TBI without other injury (e.g. concussion. sah, contusion, etc)). ends up on our service. ICH at my institution goes to neurology. We operate on ICH probably 1 in 20. We really try not to, STICH shows it's not worth it unless they're obtunded.

 

[Pseudostrategy]

Hey @neusu

First of all, thank you so much for creating this thread. It has answered a lot of important questions for aspiring neurosurgeons such as myself and many others. We appreciate your time and honesty.

I have a question for you regarding research.

Currently I am an undergraduate student at a small Midwest university. Throughout the last couple years I have been shadowing a neurosurgeon at the University nearby. Needless to say, I have fallen in love with neurosurgery since the first operation that I observed. That said, I am trying to get involved in research this upcoming summer, since the academic year doesn't permit me to do research, as I am involved in varsity athletics.

Currently I am split between two labs:

Lab A: Is a neural stem cell/translational neuroscience laboratory that is run by a neurosurgeon. I have been to a few lab meetings and it seems as though I would be stuck doing scut work and not necessarily learning how to be an effective researcher. But, like I said above, it is neurosurgery related and I feel like it could possibly benefit me in the residency match process.

Lab B: Is a cancer/cell biology lab that investigates apoptosis in leukemia cells. In this lab however, I feel that the PI (PhD only) is much more involved and I would get a much more in depth experience and learn how to do things better. But as stated previously, it isn't exactly neurosurgery or even neuroscience related.

I also plan to take 2 years off after the completion of my undergraduate degree to possibly work in one of the labs listed above full time. In the context of becoming a competitive applicant for both medical school and neurosurgery residency, which lab would you recommend?

Thanks a lot and I apologize for the long question.

 

[Gauss44]

Do you know if an excellent Step 1 score, excellent GPA, and excellent recommendations are enough to get into a neurosurgery residency these days, or if one needs related experience (ex. neurology or surgery research, etc.) prior to medical school?

 

[FictiousForce]

5. Not sure what you mean by "cognitive computing" but I'll assume you mean either machine:brain interfaces or computational learning. We are involved in both fields. The former, basically, trying to understand the neural circuitry at a level that we can create an interface with a computer to read brain signals and create an appropriate response. The latter, creating algorithms using our understanding of signal integration and checking in neurons to model software to understand large, complex data sets. With the recent advances in technology the next 20 years will be amazing with respect to our ability to both understand data and create systems for neural integration.

Could you talk a bit more about the extent to which neurosurgeons are directly involved in this field and what avenues there are for a student to participate here?

Are you familiar with any major labs affiliated with hospitals/medical schools that do this kind of research? I'm speaking particularly about neural interfaces, neural circuity, the kind of thing that would presumably lead to better neuroprosthetics and "brain implants" (which I assume neurosurgeons would be physically implanting should such things come to fruition).

 

[neusu]

As an attending, how many of your ~300 or so operations per year would you estimate ending up with the patient severly debilitated or even dead due to intra or post operative complications? Is it more in cerebrovascular?

This is highly variable depending on practice. As suggested, an academic neurosurgeon at a referral center in a more high risk field such as cerebrovascular or skull base surgery will likely have more killed/maimed patients from intraoperative complications than the typical lami/disc private practice counterpart. Elective procedures tend to be less risky than emergent. Even so, we deal with a high risk field. Say the quoted risk for a procedure is 15%, that would put it at 45. Generally, not every procedure carries that risk however.

 

[jram2323]

This is highly variable depending on practice. As suggested, an academic neurosurgeon at a referral center in a more high risk field such as cerebrovascular or skull base surgery will likely have more killed/maimed patients from intraoperative complications than the typical lami/disc private practice counterpart. Elective procedures tend to be less risky than emergent. Even so, we deal with a high risk field. Say the quoted risk for a procedure is 15%, that would put it at 45. Generally, not every procedure carries that risk however.

Thank you for the reply. Seems like a fairly high number--I would think it takes a a lot of resilience to handle that.

 

[Dr.Sticks]

I've always wanted to be a neurosurgeon ever since I was a kid.

Alright my question; Does neurosurgery offer a lot of variability in Job location, or would you have to be in a big city?
I wonder if the Neurosurgeons in these high demand areas have higher pay as well.

Oh, and not sure if asked before.. But what's your favorite part of neurosurgery, and what do you think about neuro-onc surgery?

 

[neusu]

I never understand why people are so discouraging

Insecurity? Assohleishness?

/encountered both

 

[neusu]

Easier to drag others down than lift yourself up.

Yes. This is absolutely true. In my program it was prevalent for so long.

We changed our culture, instead of trying to avoid getting stabbed in the back while stabbing someone else in the back we are constantly pumping eachother up like a bicycle pump.

It takes time, takes the right people. You guys don't realize, but picking the right next residents and, even if they aren't, giving them space to fit in the system, is so, so important

 

[barsoum.michael]

Do you believe there will be shortages of neurosurgeons in the next decade or so? With all the things going against us

 

[Psai]

All the people in my class that came in saying they were doing neurosurgery switched to ortho or ent. 7 years is too long

 

[neusu]

Hey @neusu

First of all, thank you so much for creating this thread. It has answered a lot of important questions for aspiring neurosurgeons such as myself and many others. We appreciate your time and honesty.

I have a question for you regarding research.

Currently I am an undergraduate student at a small Midwest university. Throughout the last couple years I have been shadowing a neurosurgeon at the University nearby. Needless to say, I have fallen in love with neurosurgery since the first operation that I observed. That said, I am trying to get involved in research this upcoming summer, since the academic year doesn't permit me to do research, as I am involved in varsity athletics.

Currently I am split between two labs:

Lab A: Is a neural stem cell/translational neuroscience laboratory that is run by a neurosurgeon. I have been to a few lab meetings and it seems as though I would be stuck doing scut work and not necessarily learning how to be an effective researcher. But, like I said above, it is neurosurgery related and I feel like it could possibly benefit me in the residency match process.

Lab B: Is a cancer/cell biology lab that investigates apoptosis in leukemia cells. In this lab however, I feel that the PI (PhD only) is much more involved and I would get a much more in depth experience and learn how to do things better. But as stated previously, it isn't exactly neurosurgery or even neuroscience related.

I also plan to take 2 years off after the completion of my undergraduate degree to possibly work in one of the labs listed above full time. In the context of becoming a competitive applicant for both medical school and neurosurgery residency, which lab would you recommend?

Thanks a lot and I apologize for the long question.

Tough question.

1) Why do you want to take 1-2 years off to do research? Do you think you perhaps would like research as a career? Are you not competitive for medical school?

2) Are you a self starter? How good are you with people?

Answer explanations from my end:

1) If you want to do research, get started now. Literally, the sooner the better. Go to grad school or work as a post-grad. There really is no reason you shouldn't be able to go straight to medical school. If your grades are ****ty, then that makes a bit of a difference. Yes, you can hang around and boost your GPA/get pubs etc.

2) If you need someone to tell you what to do constantly go to the oncology lab. Having an involved, motivating PI is certainty something to take when it's available. If you're a self starter and think you can make a name for yourself go tot he neurosurgery lab. Going from bottle washer to having a project that gets published is impressive.

That being said, regardless of where you end up for research, go to the lab that publishes more. The rule is publish or perish. If you didn't put it in writing, you didn't do it.

 

[Pseudostrategy]

Tough question.

1) Why do you want to take 1-2 years off to do research? Do you think you perhaps would like research as a career? Are you not competitive for medical school?

2) Are you a self starter? How good are you with people?

Answer explanations from my end:

1) If you want to do research, get started now. Literally, the sooner the better. Go to grad school or work as a post-grad. There really is no reason you shouldn't be able to go straight to medical school. If your grades are ****ty, then that makes a bit of a difference. Yes, you can hang around and boost your GPA/get pubs etc.

2) If you need someone to tell you what to do constantly go to the oncology lab. Having an involved, motivating PI is certainty something to take when it's available. If you're a self starter and think you can make a name for yourself go tot he neurosurgery lab. Going from bottle washer to having a project that gets published is impressive.

That being said, regardless of where you end up for research, go to the lab that publishes more. The rule is publish or perish. If you didn't put it in writing, you didn't do it.

Thanks for the response @neusu

Relating to your questions:

1) The primary reason that I want to take two years off before medical school is because I don't have the time during my undergraduate years to get involved in any meaningful research, as I work part time and am involved in athletics. Therefore, taking a couple of gap years will allow me to get involved in research and learn how to be a better researcher prior to entering medical school. In that sense, I can "hit the ground running" once I enter medical school and jump in on a project and make some decent contributions right away instead of taking a significant amount of time to learn the basics, etc. Grades are not an issue, so I can fully devote my time off to working on a project.

I also have another question for you:

Is it possible for undergraduates to get involved in writing clinical papers relating to neurosurgery? If so, how do I go about approaching the attending whom I've been shadowing (or the PI of the lab I might be working in) and let them know of my interest in helping on a clinical paper?

 

[jukeboxhero]

Hello, I am currently a critical care nurse working in ER and ICU. I have a question regarding the placement of ventriculostomy catheters. Why do physicinas insert at Kochers point rather than using a tunneling device to access the ventricle via the longitudinal fissure (effectivly saving the needle until right when we are superior to the corpus collosum) ? This is probably an easy one for many of you but I am just curious why do we insert a needle directly through brain tissue whe we could (or maybe we can't- I dn't know) minimize that by utilizing the fissure that is already there? Ive seen the procedure done , I just don't understand the "why" behind it. Thanks in advance

 

[accarpe2]

Hi, currently I am still pre-med and finishing up my degree in biomedical engineering. I was wondering if you have ever had any complaints (even the most minor) with any of the equipment you have to use as a neurosurgeon. I am trying to get an idea for my senior thesis and I really would like to work on something that could possibly benefit the field of neurosurgery before I attempt to be a part of it myself. It could even be something as simple as a certain piece of equipment not having been improved upon in a few years.
Thank you for your time! I really enjoy reading your forum.

 

[ScrubsMD]

I have few questions, some of which may have been asked but I'll throw them out there. Thanks for doing this!

1. Do you have any regrets going the Neurosurgery route? If so, what would you have done differently?

2. Longest span of time you spent awake in the hospital? Were you seeing patients/operating throughout this?

3. Any advise for someone who doesn't have a home neurosurgery program?

 

[neusu]

Do you know if an excellent Step 1 score, excellent GPA, and excellent recommendations are enough to get into a neurosurgery residency these days, or if one needs related experience (ex. neurology or surgery research, etc.) prior to medical school?

This really depends on the program. I can only really speak for my program and what we look for, as it is the only program I have been involved in the process of reviewing applications and making our rank list. We do look at those factors you mentioned, and no one factor is a guarantee (though any one can be a kill switch). Rather than ask "what is the least amount of work I can do to feel safe in my application?" Why not rephrase the question, {what factors of the application am I currently weak, and what can I do to improve upon these?"

 

[neusu]

Could you talk a bit more about the extent to which neurosurgeons are directly involved in this field and what avenues there are for a student to participate here?

Are you familiar with any major labs affiliated with hospitals/medical schools that do this kind of research? I'm speaking particularly about neural interfaces, neural circuity, the kind of thing that would presumably lead to better neuroprosthetics and "brain implants" (which I assume neurosurgeons would be physically implanting should such things come to fruition).

Sure. I'll preface this by saying I am not particularly involved in functional neurosurgery so most of what I know is generalizations.

Neurosurgeons are the doctors who implant the electrodes. There are groups across the country who are involved in research and development of a variety of different systems and models (e.g. braingate, spinegate, DBS etc.). As you can imagine, this sort of thing requires a diverse group of people to play different roles in the process (e.g. neurosurgeons/neurologists/neuroscientists to provide perspective on anatomy/physiology and targeting for devices as well biomedical/electrical/computer engineers to create hardware/software to do what it is we want). Much of the R&D takes place in animal models, and there are labs ranging from basic neuroscience to understand the connections within the brain to applied device testing or human trials wherein implants are placed for various purposes and data collected or prosthetics tested. Feel free to PM me and I'd be happy to try to give you a more specific answer.

 

[Gauss44]

This really depends on the program. I can only really speak for my program and what we look for, as it is the only program I have been involved in the process of reviewing applications and making our rank list. We do look at those factors you mentioned, and no one factor is a guarantee (though any one can be a kill switch). Rather than ask "what is the least amount of work I can do to feel safe in my application?" Why not rephrase the question, {what factors of the application am I currently weak, and what can I do to improve upon these?"

Okay, I meant, "When it comes to most applicants for your residency position in neurosurgery, would a lack of experience in a related field like neurology and/or surgery prior to medical school be likely to eliminate that candidate?" In a typical application cycle, how much would NOT having experience in neurology or surgery hurt the applicant?