Ask a neurosurgery resident anything

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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?
Every medical student rotates through surgery and neurology in third year. Obviously not every successful applicant has research in both general surgery and neurology, and research in those areas is not looked on as favorably as pure neurosurgery research. Research done during medical school is generally considered more important than research done before that. Unless you do something really impressive, nobody really cares about your CV from before med school.
 
I have a question regarding the future of neurosurgery. If I decide to become a surgeon of any kind I will be starting my residency in 2021. I have always seen myself as surgeon, but I feel that the classical image of the surgeon, the one fixing the inside of the human body by cutting it open is disappearing, but that is the way I have imagined myself for years. Is this really happening? How different from now will the education of a neurosurgeon be in the next decade? Any guesses or predictions?
I am not sure wheter I was clear or not, but I really hope to receive an answer.
 
Thank you for the reply. Seems like a fairly high number--I would think it takes a a lot of resilience to handle that.

Any time, thanks for reading.

It very well can be high for high risk procedures. That being said, the majority of what we do is not terribly high risk.
 
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?

There is quite a bit of variability in location, depending on your goal for your practice and definition of "big city." If you are content doing bread and butter neurosurgery, and a city of 30-50,000 isn't "big," there are many private practice neurosurgeons who fit this description. Trauma and CVA aside, the majority of what neurosurgeons deal with is acute, but not emergent. That is to say, you can live in the middle of nowhere Montana, have a seizure, go to your PCP, get a CT or MRI in the coming days, find a brain tumor, and be sent to the nearest neurosurgeon for a referral. The surgeons in the smaller cities generally are private practice and are fee for service so to speak.

I have a lot of favorite parts of neurosurgery. My favorite sub-specialty is cerebrovascular. I love that we are able to utilize our knowledge of anatomy and physiology to see someone, localize the lesion, confirm on imaging, and plan and perform invasive procedure wherein we avoid critical structures for making us who we are (that is to say, if things don't go well the patient can wake up unable to speak, plegic, or perhaps never wake up). The future of neurosurgery is very exciting. We are making new discoveries of how different parts of the CNS communicate with one another and how we can augment that as well as a better understanding of how things like tumors, stroke, or autoimmune diseases occur and ways to prevent or fix them.
 
This thread is amazing ! With your busy a schedule and all , I am really grateful that you're taking time to post regularly . I have read almost half of the pages of this thread .

However , I do not know whether my question has been asked before or not , if so I apologize :

Why does it seem that Neurosurgery is mainly a male dominated field ? Or is that a misconception ?

I have watched a presentation by a board certified female Neurosurgeon who stated that there are very few females in the field , that specific doctor really has an impressive resumé as a Neurosurgeon .

Are there any reasons why females in general do not find Neurosurgery appealing or that is simply erroneous ?

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

I don't think there will be a shortage of neurosurgeons. We will have to become more efficient at what we do and have better techniques for treatments.
 
All the people in my class that came in saying they were doing neurosurgery switched to ortho or ent. 7 years is too long

This is true, 7-years is a very long time. I can't fault anyone for knowing they wouldn't be happy with that decision and finding another field in which they are interested.
 
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?

We have medical students and undergraduates involved in clinical papers all the time. Generally, looking at what the department is currently doing and approaching the individuals heading up a study to get involved does the trick.
 
Hi @neusu, thanks for your help! A couple of questions:

-Do you *need* to do a fellowship in order to do certain surgeries? I watched a video about an electrode implant for a Parkinson's patient and it gave him back almost his full functionality. I think that type of surgery would be awesome, but I don't think I'd want to miss out on some of the other brain, spine and nerve procedures that neurosurgeons do as well. As a general neurosurgeon, do you get to do most kinds of procedures, or are some procedures reserved for sub-specialists?

Also, a more trivial question. Do you get to listen to music in the operating room? I know some surgeons do, but since neuro procedures are a bit more sensitive, I don't know if that would be bad practice.

Thanks for doing this!
 
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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

Interesting question.

Any time we place a catheter, needle, electrode or other instrument through the brain we have to consider associated anatomical structures. Certainly, one could argue the shortest route through brain is the best, however this is not always the case. To answer your specific question, we typically place ventriculostomy catheters at Kocher's point in the frontal region, and Dandy's point in the occipital region to avoid important structures. The cortex and white matter tracts in these regions are generally free off eloquent cortex, important subcortical white-matter tracts, and vessels. Passing through the corpus callosum, would be challenging or several reasons. Firstly, in the midline lay the superior sagital sinus. If, as you suggested, somehow tunneling from a lateral position and dropping in the interhemispheric fissure were possible, there still are the medial frontal structures such as the cingulate gyrus and the distal ACA branches. Finally, corpus callosum is an important association white matter tract between the hemispheres. While it can be sectioned with little side effect, this is possible in only certain areas. The frontal and occipital region trajectories, however, really only pas through corona radiata, which is well tolreated.

So the long and short of it is anatomy.
 
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.
 
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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!
 
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.

Oh if you only knew! We tend to complain about our equipment all of the time. Sorry this isn't of much help, is there something in particular you had in mind?
 
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?

1) No regrets. I have had second thoughts along the way, especially during the junior residency years when I was getting my ass kicked constantly. It can be hard watching your friends from college advancing in their careers, making money, starting families while you are swimming in debt and working like a machine. Likewise, it can be just as hard watching your med school classmates or residents you work with become attendings at the same institution as you while you are still a resident. Generally, they treat you well despite the title differential, but there are always those individuals who just don't get it.

2) Tough to tell. Often, if I know I'll be stuck for an extended span, if at all possible, I'll sneak off somewhere and get a cat-nap. Even 5-10 minutes can do wonders. That being said I've consistently stayed up the limit of 28-hours as a junior resident and perhaps up to 40, but then again I don't recall specifically.

3) Are you in a city with a neurosurgery program? Certainly, not having a home program can be a disadvantage both from having less exposure as well as the advocacy standpoint. Make every effort you can to show that you understand what the field is, how residency functions, and that you are both interested/capable in residency/neurosurgery and that you are the person they should pick. Plan to do 2 or 3 away rotations during your 4th year. Get as much research as you can, preferentially in neurosurgery, but in anything if neurosurgery is not an option.
 
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?
 
have you come to terms with the long term damage you are doing to your body due to lack of regular and adequate sleep?
 
If one failed to match into neurosurgery initially, what's their best shot of winding up in the field? Do a prelim surgical year and reapply? Take a research year off and reapply? Go through radiology and do NIR? I'm just wondering if there's a feasible plan B since it's so competitive and all. Thanks for doing this by the way.

Edit: Nvm, post 636 pretty much sums it up
 
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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.
 
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?

I'm not sure if I understand your question. We regularly take students who have no experience in neurology or neurosurgery prior to medical school. Having zero experience in neurosurgery prior to applying to residency simply demonstrates a lack of insight in to the application process, the work required to be successful at neurosurgery, and, frankly a poor work ethic. I suspect someone without any prior experience in neurosurgery would not receive any interviews.
 
I have a question regarding the future of neurosurgery. If I decide to become a surgeon of any kind I will be starting my residency in 2021. I have always seen myself as surgeon, but I feel that the classical image of the surgeon, the one fixing the inside of the human body by cutting it open is disappearing, but that is the way I have imagined myself for years. Is this really happening? How different from now will the education of a neurosurgeon be in the next decade? Any guesses or predictions?
I am not sure wheter I was clear or not, but I really hope to receive an answer.

Surgery certainly is changing. Procedures are becoming more minimally invasive and other treatment modalities (e.g. interventional radiology or radiotherapy) are making significant inroads. That being said, there will always be a place in medicine for neurosurgeons. Training will likely be similiar, but focused on the current standard of care.
 
Oh if you only knew! We tend to complain about our equipment all of the time. Sorry this isn't of much help, is there something in particular you had in mind?
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 🙂
 
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 🙂:kiss:
 
This thread is amazing ! With your busy a schedule and all , I am really grateful that you're taking time to post regularly . I have read almost half of the pages of this thread .

However , I do not know whether my question has been asked before or not , if so I apologize :

Why does it seem that Neurosurgery is mainly a male dominated field ? Or is that a misconception ?

I have watched a presentation by a board certified female Neurosurgeon who stated that there are very few females in the field , that specific doctor really has an impressive resumé as a Neurosurgeon .

Are there any reasons why females in general do not find Neurosurgery appealing or that is simply erroneous ?

Thank you again 🙂

Neurosurgery is mainly a male dominated field. From what I recall, females make up < 20% of neurosurgery attendings and or residents. There has been some active push to make changes to encourage more female applicants.

Residency choice and career path are individual decisions that are multi-factorial. Many women simply do not want to pursue a field with the length of training involved or the gender disparity involved in neurosurgery (or other surgical fields). Surgeons, in general, operate with an air of bravado (or arrogance, depending on your perspective), which in itself turns off many people. Likewise, men more than women seem to be motivated by machismo and legacy building.

Life has a way of catching up with us. Men have the luxury of being able to focus on school/residency (e.g. graduate hs at 18, undergrad at 22, med school at 26, and residency at 33) and not have the sense that their time to settle and start a family is limited. Having a child in residency is stressful enough to begin with. In fields which are traditionally more demanding of time, this is only amplified. Furthermore, the duration of training for neurosurgery (over 2-fold the length of may fields) is hard to rationalize when day-dreaming of a cozy future.

Over the years, I have watched many friends, male and female alike, with similar goals and grand aspirations at the outset, confront these decisions as they arise and filter in to a variety of other fields. While some, clearly, are ultimately unhappy with their decision, the majority are happy and successful in their own right.
 
Do you think surgery simulation will shorten the training length?

Absolutely not. Simulations are no substitute to to the real thing. In some surgical specialties, simulator training can help with the learning curve for difficult technical motor memory tasks (e.g. laparoscopy). That being said, learning human pathophysiology, and the acute management therein, and how to operate through events is something that only can be taught with experience. In the same vein, the intangibles such as how you react knowing you are working on a living breathing person, communicating to the surgical team, managing the support staff in the room all are a part of the surgery. Finally, the operating room is only part of training. There is also the hospital stay and pre- and post-operative outpatient management.
 
Hi @neusu, thanks for your help! A couple of questions:

-Do you *need* to do a fellowship in order to do certain surgeries? I watched a video about an electrode implant for a Parkinson's patient and it gave him back almost his full functionality. I think that type of surgery would be awesome, but I don't think I'd want to miss out on some of the other brain, spine and nerve procedures that neurosurgeons do as well. As a general neurosurgeon, do you get to do most kinds of procedures, or are some procedures reserved for sub-specialists?

Also, a more trivial question. Do you get to listen to music in the operating room? I know some surgeons do, but since neuro procedures are a bit more sensitive, I don't know if that would be bad practice.

Thanks for doing this!

All neurosurgeons who finish a residency program and are board eligible are able to perform any surgery.

Many parts of neurosurgery are very skill-set heavy and technically challenging. Being a general practice neurosurgeon, the frequency with which surgeries for each of these sub-specialities would be performed would be less frequent than someone who specialized solely in that field. Many pursue fellowship in a particular area to gain further, specialized training in that field. To that end, programs with fellowships tend to have a higher volume and handle the more complex cases in those fields. So, while in theory, every neurosurgeon can do every case, in practice we know our limitations. If I haven't clipped a basilar tip aneurysm in 10-years, when one comes in that needs to be clipped I will refer it to my colleague who is more familiar with that procedure. Vascular, spine, pediatric, and skull base tumor cases tend to be sent on to someone who has done a fellowship in that field.

I do enjoy music in the OR. Typically, though, once the microscope comes in the music is turned off.
 
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.
 
@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.
 
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.
You absolutely don't need to be in the top 10% to match. Most who do aren't even AOA.
 
Alpha Omega Alpha, think of it like PBK for Medical Students.
Go to page 147 for the data I am talking about. http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

Clearly, getting AOA won't hurt you. Those who get AOA match at a high rate, BUT you have to consider people who get AOA probably have at least decent board scores and are pretty driven people for the most part. More people matched overall without having AOA compared to those who did, from a raw number perspective not a percentage.

And for reference, I believe AOA is supposed to be the top 1/6th of a class, as an FYI (tbh I am not AOA and I am by far not in the top 10% but matched anyway). If you actually look at the numbers in charting the outcomes, neurosurgery is really not that competitive relative to derm, plastics, ent, and even so slightly ortho. Just work hard, get a decent step, do research, and impress your home program and you should match somewhere. If you want to match at "top 10" program that is a different ball game.
 
Just work hard, get a decent step, do research, and impress your home program and you should match somewhere. If you want to match at "top 10" program that is a different ball game.

So what about the "top 10" programs, then?
 
You absolutely don't need to be in the top 10% to match. Most who do aren't even AOA.

Thanks for the reply. That's reassuring to hear and I see what you're saying from the charting outcomes. I'm just concerned because I've frequently read that you MUST have honors/ mostly honors even in your preclinical classes to be competitive and that, at one of my accepted schools, honors is only attainable for me if I score in the top 10% of the class. Like you said, most people who match neurosurgery aren't in the top 10% of their class. So would going to a school with such a grading system actually hurt my chances at neurosurgery if I'm unable to make the top 10% and receive the honors mark?
 
Thanks for the reply. That's reassuring to hear and I see what you're saying from the charting outcomes. I'm just concerned because I've frequently read that you MUST have honors/ mostly honors even in your preclinical classes to be competitive and that, at one of my accepted schools, honors is only attainable for me if I score in the top 10% of the class. Like you said, most people who match neurosurgery aren't in the top 10% of their class. So would going to a school with such a grading system actually hurt my chances at neurosurgery if I'm unable to make the top 10% and receive the honors mark?
It won't hurt your chances. Going to the school without the grading system would make your life a lot easier during 3rd year, however. Do both programs have home neurosurgery departments? If only one does, go to that one. Is one more prestigious? If so, I would consider going to that one. The name of your school counts for more than you think it should it surgery subspecialties.
 
This statement is completely wrong. You can adjust your questions accordingly.

Thanks. I appreciate your help.

It won't hurt your chances. Going to the school without the grading system would make your life a lot easier during 3rd year, however. Do both programs have home neurosurgery departments? If only one does, go to that one. Is one more prestigious? If so, I would consider going to that one. The name of your school counts for more than you think it should it surgery subspecialties.

I see. Both schools do have home neurosurgery programs. The more prestigious of the two schools would be Georgetown.
 
As someone who's been highly involved w/NS before and during med school, I reiterate all that was said. 👍 @tiedyeddog Also, grats on matching. Maybe you can take the helm on the thread as neusu climbs the ladder and has less time. 😉

Ahem, there is more than one nsg resident on this forum 😉
 
Any advice for interns about to start in ~3 months?

If you have strong research interests, try to get them started before residency (write IRBs, meet with professors), because once you his the wards you are going to be very much pressed for time in the beginning at the very least.

Other than that, not much you can do to prepare. Frankly, memorizing phone numbers to the floors and ORs is probably going to save you more time than reading greenberg, etc. The reason is the vast majority of the things that will fall to you will be highly specific to that hospital and program. Even the way you do things like lumbar punctures, opening, and closure of cases can vary.
 
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?
 
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?
Not really. Perhaps for a short time in basic science research but not by much compared to what you'll learn in medical school.
 
If you have strong research interests, try to get them started before residency (write IRBs, meet with professors), because once you his the wards you are going to be very much pressed for time in the beginning at the very least.

Other than that, not much you can do to prepare. Frankly, memorizing phone numbers to the floors and ORs is probably going to save you more time than reading greenberg, etc. The reason is the vast majority of the things that will fall to you will be highly specific to that hospital and program. Even the way you do things like lumbar punctures, opening, and closure of cases can vary.
Thanks for the excellent advice! 👍
 
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