Ask a neurosurgery resident anything

[neusu]

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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...

You certainly can make a living in a niche specialty. Will you be making as much money as your partners? Undoubtedly no. If you are willing to tough out residency and forgo the extra pay spine would provide out in practice, you can do only DBS (or tumors, or epilepsy, or aneurysms, etc). Most people rationalize a little of things they don't like (spine, trauma, pedi, cranial) to be able to do mostly what they do like is a fair trade.

 

[neusu]

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!

It is a nascent field, but there is active research on neuroregeneration with respect to memory and spinal cord injury.

 

[neusu]

@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

I have never heard of a surgeon snapchatting a case.

Funny you ask about wearing a GoPro. I've been looking in to the HD-camera headlights as of late. We currently record most of what we do under the microscope, but I use my loupes for a lot of things. That being said, most of this would not end up youtube.

For advanced cases, this may be a bad explanation, but the most difficult part is the combination of the two. It becomes a bit of a mind game, or puzzle, to work through as the surgery proceeds. I know the anatomy, know the variants of anatomy, but every patient's individual anatomy is different. I studied the films, but they only provide so much information. Every case has several goals, first and foremost of which is keeping the patient safe. When I was a student, I'd often gloss over many of the minor details in my head, but looking back many of them become far more important than I gave them credit for. Even a simple lumbar discectomy that goes amazingly well operatively can become a nightmare if you were careless during positioning and didn't pad the axilla or make sure they eyes were free. While getting the disc out is the over-arching goal, there are points along the way that need to be reached to safely proceed. So, in the midst of a complex case, I tend to focus on the current task, taking care to best position myself for the next task. In the "critical portion" of the case, it becomes another routine event among many. Thus, knowing the anatomy and physiology of the tissue and the technical uses of intruments to achieve the overreaching goal go hand in hand.

I'd have to say, as a runner, I have never experienced "the zone" while operating. Perhaps I am thinking of something different. That being said, I have noticed many times while operating that I was so focused on something that I forgot to blink.

 

[neusu]

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.

You are correct, I seem to be able to go on 4-6 hours of sleep. Even if I can sleep in, I tend to wake up after 6 hours on my own. Growing up I could sleep 8 or more hours, but as I matured it became less necessary. I can't say I have really discussed sleep needs with other residents. We all know we could probably use more sleep, but no one is going to make a point of it. There is an espirit de corps among residents to not complain how bad we have it to one another.

 

[neusu]

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

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

Indeed.

 

[neusu]

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?

There are a multitude of physically exhaustive parts of neurosurgery. Like any surgical residency our hours are long, call frequent, and days off the minimum. Many of our cases are long (it is not uncommon to have cases that go 6, 8, 12, 14 hours). For spine or interventional we wear lead which adds to the weight on your feet while standing for extended periods.

I think I discussed case length and workday/week previously, but a recap: short cases (1-3 hours) shunts/non-instrumented spine/some craniotomies/functional. Long (>4 hours) instrumented spine/some craniotomies/some functional. Very-long (>12 hours) skull base tumors/long spine constructs/functional cases with a lot of monitoring/some vascular. Residents generally work 80 hours a week and it varies a lot by year and program. Attendings work what they want and it varies by practice model. I would suspect though the median is around 60 hours for attendings.

 

[neusu]

@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.

Bulbocavernosus is used to assess completeness of spinal cord injury. For a patient who is ASIA A (no motor or sensory), lack of a bulbocavernosus indicates the patient may still be in spinal shock and function masked. Return of mono- or poly- synaptic reflexes indicates absence of spinal shock and the true exam. Bulbocavernosus is used because it tests sacral roots which are most distal in the spinal cord. To test in a woman pull on the Foley catheter while performing a DRE.

It is performed routinely in wake patients with SCI for the aforementioned reasons. If they have a sensory level, testing distal to the level is important.

 

[neusu]

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. 🙁

It really can be disheartening and make you question humanity. As a service, we try to be objective and be there to do a job. Even so, when moral or ethical conflicts arise, it can be hard to maintain objectivity. We have had some heated discussions behind office doors about management of patients.

 

[mkp]

It really can be disheartening and make you question humanity. As a service, we try to be objective and be there to do a job. Even so, when moral or ethical conflicts arise, it can be hard to maintain objectivity. We have had some heated discussions behind office doors about management of patients.

Hi neusu,

First off, I really appreciate the time you're taking to respond to all of us. A little about me. I have a Masters degree in neuroscience as well as an MS in medical sciences. I am applying to medical school this year and in the meantime have landed a research assistant position in the neurosurg dept at BCM in Houston. I will be working with a neurosurgeon and some of the projects I will be working on include determining accuracy for MR- guided laser ablation, DBS mice models for epilepsy and also understanding electrical fields in HH.

My concern was primarily from a previous post I read about how anything pre-Medical school won't be considered. If I am considering neurosurgery, will having a full time research position under a neurosurgeon doing both clinical and basic research before I began medical school be looked upon favorably?

 

[Gauss44]

A student of mine wants to know if you have to shower at work and how private the showers are (ex. open room without dividers, shower stalls, etc.)? My student doesn't want to be seen nude....

 

[slow twitch]

There are a multitude of physically exhaustive parts of neurosurgery. Like any surgical residency our hours are long, call frequent, and days off the minimum. Many of our cases are long (it is not uncommon to have cases that go 6, 8, 12, 14 hours). For spine or interventional we wear lead which adds to the weight on your feet while standing for extended periods.

I think I discussed case length and workday/week previously, but a recap: short cases (1-3 hours) shunts/non-instrumented spine/some craniotomies/functional. Long (>4 hours) instrumented spine/some craniotomies/some functional. Very-long (>12 hours) skull base tumors/long spine constructs/functional cases with a lot of monitoring/some vascular. Residents generally work 80 hours a week and it varies a lot by year and program. Attendings work what they want and it varies by practice model. I would suspect though the median is around 60 hours for attendings.

What makes neurosurgery cases so long? Does the delicate nature of the work require you to work slowly or are there a lot of "steps" that need to be completed for surgeries.

 

[neusu]

Hi neusu,

First off, I really appreciate the time you're taking to respond to all of us. A little about me. I have a Masters degree in neuroscience as well as an MS in medical sciences. I am applying to medical school this year and in the meantime have landed a research assistant position in the neurosurg dept at BCM in Houston. I will be working with a neurosurgeon and some of the projects I will be working on include determining accuracy for MR- guided laser ablation, DBS mice models for epilepsy and also understanding electrical fields in HH.

My concern was primarily from a previous post I read about how anything pre-Medical school won't be considered. If I am considering neurosurgery, will having a full time research position under a neurosurgeon doing both clinical and basic research before I began medical school be looked upon favorably?

Sorry if I misrepresnted anything, things you do pre-medical school certainly are considered. Having a neuroscience background, in and of itself, is no leg up to residency when compared to any other background. Your research experience will help. Make sure you get published.

 

[neusu]

A student of mine wants to know if you have to shower at work and how private the showers are (ex. open room without dividers, shower stalls, etc.)? My student doesn't want to be seen nude....

Interesting question. I have showered at work. We have private showers. They are stalls with a curtain. You hang your clothes on a hook in a vestibule. Incidentally, the only reason I did is that I had to put a halo on in a trauma room wherein they kept the temperature high (e.g. 100 F). I sweat through my scrubs and decided before morning rounds a shower was in order.

More importantly.. Your status says you are a pre-med. You mention students. Are you a teacher of sorts?

Personally, since this is the elephant in the room, group showering is nothing to be afraid of. I was petrified in middle and high school that we would have to take showers with one another. Nope. Never happened.

During that time I even went so far as to wear shorts to the shower should I have to be in a group shower.

Sometime in my 20s I stopped caring. Seeing another guy naked, ok. Them seeing me naked, who cares?

Your body is what it is. Learn to accept it. You can change it to some degree with your diet and exercise, or lack thereof. That being said, the vast majority of the other people in the world have little interest in seeing it, and think nothing of it if they happen to by chance in the locker room.

 

[neusu]

What makes neurosurgery cases so long? Does the delicate nature of the work require you to work slowly or are there a lot of "steps" that need to be completed for surgeries.

Interesting question. I have often asked myself this same question. Why are our cases always so long and many others, e.g. straight general surgery, easy ENT etc so much shorter.

Our easiest shortest cases (arguably). 1) DBS/VNS stimulator change: time 30 minutes. On par with gen surg. 2) Pump change: easy can get csf 20 min, not easy/no csf 40 minutes. Still on par with gen surg. Simple laminectomy/discectomy: 30 - 90 min. We fall behind gen surg. Not only do we have to dissect the muscle off the spinous process, we have to drill it down. Then we have to take that eggshell up and get rid of the ligament. Find the disc space, incise it. Take it out. Can/have I done it in 30 minutes? Yes. Is it a reasonable expectation for every disc? No. Add in dissection over the lateral structures. Add in hardware placement. So on so forth. No wonder a T10-Iliac fusion takes all day!

In a similar vein. I am operating on the brain as a goal. Skin/muscle/bony dissection takes an hour. Open dura.
1) Intraoperative testing? takes forever
2) sub pial or intra-arachnoid dissection, meticulous
3) it's brain surgery, it will take a while...

We are purposeful people doing important things for our patients.. it takes a long time because we have a lot to consider in each decision we make.

 

[Guero]

Interesting question. I have showered at work. We have private showers. They are stalls with a curtain. You hang your clothes on a hook in a vestibule. Incidentally, the only reason I did is that I had to put a halo on in a trauma room wherein they kept the temperature high (e.g. 100 F). I sweat through my scrubs and decided before morning rounds a shower was in order.

More importantly.. Your status says you are a pre-med. You mention students. Are you a teacher of sorts?

Personally, since this is the elephant in the room, group showering is nothing to be afraid of. I was petrified in middle and high school that we would have to take showers with one another. Nope. Never happened.

During that time I even went so far as to wear shorts to the shower should I have to be in a group shower.

Sometime in my 20s I stopped caring. Seeing another guy naked, ok. Them seeing me naked, who cares?

Your body is what it is. Learn to accept it. You can change it to some degree with your diet and exercise, or lack thereof. That being said, the vast majority of the other people in the world have little interest in seeing it, and think nothing of it if they happen to by chance in the locker room.

Adding to both question and answer, the call rooms I've seen at two institutions usually have a shower with a curtain or an entirely separated door. NS programs also tend to have smaller call rooms than other larger programs (e.g., internal med, gen surgery) based simply on number of residents accepted (NS ~2/yr vs IM ~15+/yr). I've never seen group showers; but I've not had a large sample size yet. They probably exist at some of the older hospitals.

@neusu Granted, for many, the bashfulness of nudity is easy to overcome. However, I'd respectfully like to underscore that some of this perceived bashfulness might be more serious and well founded than one might expect. For instance, some students and residents may've endured genital surgeries (e.g., 2/2 being designated intersex at birth). Some may also identify as transgender and/or non-binary, fearing prejudice or even violence from certain staff, superiors, or peers. Some may have suffered prior trauma that could trigger by being naked and vulnerable around others. I feel it's very important for us all to keep those and similar issues in mind when we perceive not only our peers, but our patients.

Clearly, it's not the norm. But I like to lend a voice to our LGBTQIA peers and our peers that've survived abuse every chance I see a relevant example. Hope it was well received/helpful. 🙂

Cheers,
G

 

[behniaahmadi]

Hi Dr. neusu. I'm an IMG and I'm interested in getting neurosurgery residency in the US. But I'm sort of confused, so i wanted to ask your advice. which way should I choose? doing residency at my home country then doing my community commitment and after that doing a couple of years research at some institutes in the US then applying for nerusurg or doing phd in in neuroscience in the US after medical school and then go for residency? note that I love both neruosurgery and neuroscience and it doesn't bother me doing a PhD, but I do not like to spend my whole life in a lab.So I want to do the thing that increases my chances in getting matched. thank U

 

[philosonista]

Hello, neusu!!!

I've been excited to ask a surgeon a question for some time now before I realized, ah, yes, neusu could answer!

So, neusu, how much of your day is consumed by paperwork? How does your paperwork load differ from other specialties?

Thank you!

 

[neusu]

Hi Dr. neusu. I'm an IMG and I'm interested in getting neurosurgery residency in the US. But I'm sort of confused, so i wanted to ask your advice. which way should I choose? doing residency at my home country then doing my community commitment and after that doing a couple of years research at some institutes in the US then applying for nerusurg or doing phd in in neuroscience in the US after medical school and then go for residency? note that I love both neruosurgery and neuroscience and it doesn't bother me doing a PhD, but I do not like to spend my whole life in a lab.So I want to do the thing that increases my chances in getting matched. thank U

This is tough to say. Getting involved in a department of neurosurgery in the US would be the best way to try to get a residency here. With the former, at least if things didn't work out, you'd be able to practice in your home country. Where are you from, by the way?

 

[behniaahmadi]

This is tough to say. Getting involved in a department of neurosurgery in the US would be the best way to try to get a residency here. With the former, at least if things didn't work out, you'd be able to practice in your home country. Where are you from, by the way?

Hi. Thanks for your reply🙂. I'm from Iran. Neurosurgery residency is not very competitive in Iran, but my concern is I might not be able to conduct a research project that could get published in journals like Nature, research funds are so tight. Would it be a real problem? And how much could USMLE scores and medical school grades compensate this issue?

 

[HCushing]

Hi Neusu. I am a MS3 at a medical school in the US. I was wondering about the importance of clinical grades. The two rotations that I have taken so far are pediatrics and medicine. I earned a High Pass in pediatrics and I'm fairly certain I am going to get Honors in medicine (after seeing my shelf grade and evaluations). My question is how important are the non-surgical clinical grades when applying for neurosurgery? I am trying my best to honor every rotation but I slipped up in pediatrics. However, from reading on SDN I found that most people seem to suggest that Step 1, LORs, and research are more important that clinical grades? Would you say this is true?

I apologize if you have already answered this question.

Thanks.

 

[neusu]

Hello, neusu!!!

I've been excited to ask a surgeon a question for some time now before I realized, ah, yes, neusu could answer!

So, neusu, how much of your day is consumed by paperwork? How does your paperwork load differ from other specialties?

Thank you!

Most of our "paperwork" anymore is on the computer. It does take up a significant portion of the day: daily notes, orders, checking labs and imaging results. Likewise, it seems the medicolegal system keeps adding more and more requirements of documentation and cya for things.

 

[el_pistolero]

hello @neusu !
I'm a fourth year medical student (in 6-year system). Obviously not an American 🙂

How does stereotactic radiosurgery change neurosurgical practices in the US? Does it diminish operative neurosurgery volumes? Skull base tumors, specifically? I mean, it seems like Gamma Knife can treat literally almost all CNS pathologies previously managed operatively by neurosurgeons! From small meningiomas to AVMs to TNs to schwannomas to pituitary adenomas...

Here in my country we only have 2 Gamma Knife systems for 260 million people, so we still don't quite get the picture. 😀

Thanks! Sorry for poor english though 🙁

 

[scoops619]

Hi @neusu, I'm an undergrad with a prosthetic eye. This affects my depth perception a bit. Not enough to affect normal, every day life, things like driving, or sports/my hand-eye coordination; however, on occasion this can really mess with my ability to make small movements precisely. I've always been fascinated by the brain and would love to eventually be a neurosurgeon (lots of steps between then and now, I know), but am competitive enough to want to excel in whatever field I end up in. Do you think that this would hinder my ability to successfully perform neurosurgical operations?

 

[neusu]

Hi. Thanks for your reply🙂. I'm from Iran. Neurosurgery residency is not very competitive in Iran, but my concern is I might not be able to conduct a research project that could get published in journals like Nature, research funds are so tight. Would it be a real problem? And how much could USMLE scores and medical school grades compensate this issue?

Again, tough call. As I said, a job is better than no job, so perhaps doing your residency and trying to come to the US is a better standpoint. The other side of the coin, if you come ot the US, do a PhD even, and still don't match, what are you left with? These are personal decisions that everyone makes. Certainly, with a PhD from a US university you could find adequate employment in the US (or Iran I hope). Would it be practicing neurosurgery? No. The former, at least you could practice in Iran.

 

[neusu]

Hi Neusu. I am a MS3 at a medical school in the US. I was wondering about the importance of clinical grades. The two rotations that I have taken so far are pediatrics and medicine. I earned a High Pass in pediatrics and I'm fairly certain I am going to get Honors in medicine (after seeing my shelf grade and evaluations). My question is how important are the non-surgical clinical grades when applying for neurosurgery? I am trying my best to honor every rotation but I slipped up in pediatrics. However, from reading on SDN I found that most people seem to suggest that Step 1, LORs, and research are more important that clinical grades? Would you say this is true?

I apologize if you have already answered this question.

Thanks.

I have been in the application review meeting for the last several years. I'm sure every program has some sort of cut-off for things like scores etc. Or perhaps they don't. In any case, we get all of our applications together (whether they are filtered or not, I couldn't tell you), and they are sent out to the attendings. Each application is reviewed by 2 attendings. Those that get 2 positive reflections get an automatic invitation, those that get one positive and one negative are looked at further, and those that get two negatives are discarded. You would have to ask each indvidual attending for their particular screening criteria. My personal criteria goes something as follows: Letters, research, school name, boards, grades, personal statement, extracurriculars, Dean's letter. After that, we grant interviews on a rolling basis, the more favored applicants are invited first, the less later. We have several dates, I'd have to ask our coordinator how she does it, but I think she tries to book each date so she'll send an email, fill and put you on the wait list, send another email etc. Then when people cancel/trade swap things around. So far as I'm concerned interviews matter for ****. I already have an impression of you based on your application. You can either validate my opinion or make it worse. Rarely, does the interview improve you. After that, we fill out a sheet on you to give you a score based on the aforementioned qualities. Then we have the rank list meeting. More often than not, unless you're a stud superstar pimp, some attending will ding you for something stupid. What kills you is if all the attendings ding you for things, or more than one ding you for the same thing. Thus, grades don't matter, but they do. At every program, there is the poindexter Straight A type who thinks every neurosurgery resident should be a poindexter straight A type, and if you got a B (or HP or P) you don't belong. So, does it matter? Yes and no. You'll likely match. Will you dictate where you match? Perhaps if you make an amazing impression. Otherwise it's rolling the dice.

 

[neusu]

hello @neusu !
I'm a fourth year medical student (in 6-year system). Obviously not an American 🙂

How does stereotactic radiosurgery change neurosurgical practices in the US? Does it diminish operative neurosurgery volumes? Skull base tumors, specifically? I mean, it seems like Gamma Knife can treat literally almost all CNS pathologies previously managed operatively by neurosurgeons! From small meningiomas to AVMs to TNs to schwannomas to pituitary adenomas...

Here in my country we only have 2 Gamma Knife systems for 260 million people, so we still don't quite get the picture. 😀

Thanks! Sorry for poor english though 🙁

Good question.

There is a lot of data out there suggesting that stereotactic radiosurgery is nearly as effective as primary resection for both solitary metastasis as well as certain types of skull base tumors and/or pain phenomenon. Fortunately, neurosurgeons have been insightful on this front and continue to play a significant role in the management of patients who undergo stereotactic radiosurgery. That being said, as a surgeon, and one who does stereotactic radiosurgery, I think the knife is the best way to ensure the most rigorous removal of these tumors. Likewise, there are many, many skull base tumors that are refractory to radiosurgery (chordoma for example).

My belief, is that radiosurgeruy will play a major role in the future, with neurosurgeons involved. We will be there both to plan the radiosurgery, and as backups, for the cases that fail. Likewise, for the cases that are untreatable with radiosurgery, there always needs to be a surgeon. Most of the skull base approach techniques take years and years and years of practice. There really are not that many who do it well. Despite the "dwindling number of cases," there will always be skull base neurosurgeons. Perhaps, the average private practice neurosurgeon won't be doing accoustics or MVDs any longer. Nonetheless, the guys who write the books will be doing clival chordomas so long as the exist.

 

[BrainPains]

Hello @neusu , long-time reader of your thread. Current 4th year medical student on the away rotation circuit. For rotating students you have observed, what are some things or stories that have made a visiting student stick out to you in a really positive way? Likewise, anything (apart from major no-no's) that left a lasting negative impression? Thanks for sticking with this over the years!

 

[neusu]

Hi @neusu, I'm an undergrad with a prosthetic eye. This affects my depth perception a bit. Not enough to affect normal, every day life, things like driving, or sports/my hand-eye coordination; however, on occasion this can really mess with my ability to make small movements precisely. I've always been fascinated by the brain and would love to eventually be a neurosurgeon (lots of steps between then and now, I know), but am competitive enough to want to excel in whatever field I end up in. Do you think that this would hinder my ability to successfully perform neurosurgical operations?

Interesting question.

In surgery depth perception and understanding of anatomy, in real-time, in 3-dimensions is critical. I'd be a little concerned that you may not be able to compensate. Hand eye coordination is one thing. Seeing and operating in a 3D field is another

 

[IlyaR]

How nervous (if at all) were you the first time you cut?

My goal is ortho, and it fascinates me, but I can't help wonder what it feels like to truly have someone's life in your hands

 

[698344]

Hi @neusu, I'm an undergrad with a prosthetic eye. This affects my depth perception a bit. Not enough to affect normal, every day life, things like driving, or sports/my hand-eye coordination; however, on occasion this can really mess with my ability to make small movements precisely. I've always been fascinated by the brain and would love to eventually be a neurosurgeon (lots of steps between then and now, I know), but am competitive enough to want to excel in whatever field I end up in. Do you think that this would hinder my ability to successfully perform neurosurgical operations?

Oh man, anything messing with your ability to make small movements precisely as a surgeon sounds bad. Best of luck!

 

[neusu]

Hello @neusu , long-time reader of your thread. Current 4th year medical student on the away rotation circuit. For rotating students you have observed, what are some things or stories that have made a visiting student stick out to you in a really positive way? Likewise, anything (apart from major no-no's) that left a lasting negative impression? Thanks for sticking with this over the years!

Simply having a good attitude and being a team player does a lot to create a positive impression. Likewise, having some insight as to how the job works and what you can do to help makes it much easier for us to teach you.

 

[neusu]

How nervous (if at all) were you the first time you cut?

My goal is ortho, and it fascinates me, but I can't help wonder what it feels like to truly have someone's life in your hands

I suppose I was startled more than anything. I was an M3 on general surgery and the scrub tech hands the #10 blade up to the field and the surgeon points at me, indicating it was my opportunity to participate. I took the scalpel and made a go for it only to be berated about holding the scalpel incorrectly and to cut with the belly instead of the tip. In any case, most things in medicine are graded responsibilities. The first time I was left alone in the OR to close, or to do a case on my own it was a little nerve-racking. In all honesty, I tend to be someone who, at those key moments, takes a step back from the situation with my stream of thought and continue to work. While my mind is thinking, "oh wow, so this is being a surgeon," or "okay, this trauma patient is coding with their head open, we need to do something to safely secure this wound while ACLS proceeds," I somehow just keep moving: sewing, cutting, coagulating, and directing my team as best I can.

Not to trivialize life, but when it hangs in the balance on a daily basis, each particular event becomes less impacting. For example, in the average lower back surgery, the anesthesiologist plays a far more life supporting role than I do. In other surgeries, we play a significant role in morbidity and mortality. Often we get away with it. Place a drain at the bedside and it's too deep. First time I did that I went to the chief and nearly quit feeling like a hack. The patient did fine. To the contrary, there are always cases that haunt you. Despite doing everything perfectly a patient has a bad outcome or is too severely diseased to recover.

 

[seanthebomb]

Hi neusu,

Thank you for putting this thread together. It has been a very useful to have an insider's perspective on the world of neurosurgery.

Please forgive the naive question.

But how much overlap is there between the fields of neurointervention radiology and neurosurgery in treating aneurysms?

 

[Dr.Sticks]

Do you think there is a market for rural neurosurgery?

 

[neusu]

Hi neusu,

Thank you for putting this thread together. It has been a very useful to have an insider's perspective on the world of neurosurgery.

Please forgive the naive question.

But how much overlap is there between the fields of neurointervention radiology and neurosurgery in treating aneurysms?

I am biased, being a neurosurgeon and all, but my impression is that a neurosurgeon can do everything that a neurointerventional radiologist or interventional neurologist can do, as well as surgery. So in that sense, the ven diagrams would be a large circle of neurosurgery with a smaller circle of neurointerventional radiology inside of it.

With respect to aneurysms, both IR and neurosurgeons treat ruptured and unruptured aneurysms. Depending on the hospital, IR tends to have limited privileges for admitting patients. Neurosurgeons do the invasive procedures such as ventriculostomy drainage, craniotomy for aneurysm repair, or arterial bypass grafting.

 

[mz1990]

Hi neusu,

Thank you for keeping this thread up and running! It has been very insightful to have an insider's look into the world of neurosurgery.

I believe this question was asked before (when you were a resident), but have you decided between academic or private practice now that you've graduated? What made you choose one over the other, in the end?

 

[Petrichor1]

do you think working with mice and dissection are a technique that I should learn if I think I might want to go into surgical route? I am squeemish and I don't know how to say no to the job that my PI offered (I didn't know at first that this was what I am signing up for since the projects changed for me). I knew that eventually in my route of clinical research I will be made to do this but how could you help me get over this fear if you could go back to your younger form?

 

[neusu]

Do you think there is a market for rural neurosurgery?

How do you mean rural neurosurgery?

For the most part, neursurgical pathology is less common than other things such as hypertension, heart disease, diabetes and so on. Not everyone will need a neurosurgeon during their life. Thus, neurosurgery tends to require a relatively large catchment area to support a practice and rural areas tend to not be very densely populated.

 

[Guero]

How do you mean rural neurosurgery?

For the most part, neursurgical pathology is less common than other things such as hypertension, heart disease, diabetes and so on. Not everyone will need a neurosurgeon during their life. Thus, neurosurgery tends to require a relatively large catchment area to support a practice and rural areas tend to not be very densely populated.

I know @neusu is always strapped for time and wanted to offer a little elaboration. Most pts that require neurosurgical intervention are either emergent/urgent (e.g., trauma, sufficiently large aneurysm), in which case they're flown or ground transported to the nearest level 1 trauma facility, or elective (such as pathology found on routine check up imaging that can wait, e.g., tumor, AVM, or functional pathology [like deep brain stimulation for Parkinson's or microvascular decompression for trigeminal neuralgia]) and schedule to drive to the nearest surgeon for several evals and ultimate surgery, if deemed appropriate. Some neurosurgeons do offer clinic time and/or OR time at outlying areas once or several times a week to increase their practice catchment area, which is your best option to reach rural pts. Hope this helps add to the answer already provided by @neusu

-G

 

[QueenJames]

It varies, mostly on the attending I'm with. Most of the time it's top 40s or music from 70s/90s/90s. I've had attendings who listened to heavy metal, jazz, or techno.

any rap or hip hop?

 

[neusu]

do you think working with mice and dissection are a technique that I should learn if I think I might want to go into surgical route? I am squeemish and I don't know how to say no to the job that my PI offered (I didn't know at first that this was what I am signing up for since the projects changed for me). I knew that eventually in my route of clinical research I will be made to do this but how could you help me get over this fear if you could go back to your younger form?

There are many other research opportunities if animal research makes you uncomfortable. There are a plethora of purely clinical projects that you wouldn't need to be in the lab at all. Is it that you'd be working with animals or the surgery part that you don't like?

 

[Hitmann]

I heard neurosurgeons get sued the most compared to other specialties, is that true? Sorry if this has been asked before

 

[tiedyeddog]

I heard neurosurgeons get sued the most compared to other specialties, is that true? Sorry if this has been asked before

This is true, it has been demonstrated in the literature. http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

In any given year, 19.1% of neurosurgeons will have a malpractice case open against them which is the highest rate for any speciality. It is a very high-risk field with plenty of terrible outcomes.

 

[Cyberdyne 101]

This is true, it has been demonstrated in the literature. http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

In any given year, 19.1% of neurosurgeons will have a malpractice case open against them which is the highest rate for any speciality. It is a very high-risk field with plenty of terrible outcomes.

How's life as a neurosurgery resident? Are you enjoying it? Any surprises?

 

[tiedyeddog]

How's life as a neurosurgery resident? Are you enjoying it? Any surprises?

It's been very challenging but very gratifying. Placing an EVD to immediately save someone's life as an intern doesn't have many comparisons IMO

 

[Eternal_Premed_Struggle]

This is true, it has been demonstrated in the literature. http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

In any given year, 19.1% of neurosurgeons will have a malpractice case open against them which is the highest rate for any speciality. It is a very high-risk field with plenty of terrible outcomes.

Could you please elaborate what you mean by this? Do you mean terrible outcomes for the neurosurgeon? Also, thanks for doing this!

 

[tiedyeddog]

Could you please elaborate what you mean by this? Do you mean terrible outcomes for the neurosurgeon? Also, thanks for doing this!

There are plenty of poor outcomes, regardless if surgery is done or not. We deal with very sick patients, such as those with subarachnoid hemorrhages due to vascular anomalies, trauma, and spinal cord injury. Regardless if we do surgery or not there will be bad outcomes for the patients in some of these situations, where a bad outcome would be a permanent deficit, we try to do the best we can with what we are given. Even in non-emergent, lower risk cases things can go poorly. Bread and butter degenerative spine cases can end in paraplegia, incidentally found unruptured aneurysms may rupture while being coiled or clipped, after deep brain stimulator lead insertions patients can have catastrophic subdural hemorrhage. There are great outcomes as well but the bad outcomes can be some of the worst in all of medicine if you ask my opinion.

 

[Petrichor1]

There are many other research opportunities if animal research makes you uncomfortable. There are a plethora of purely clinical projects that you wouldn't need to be in the lab at all. Is it that you'd be working with animals or the surgery part that you don't like?

actually, over time, I have grown to get used to the mice, I tend to treat them as pets but as part of the study, they do get sick over time which makes me sad. The clinical part of this study is currently being conducted but it's someone else's assignment thus far and the project I've been put on is lab skill work. While I have no problem with this as it teaches me a really cool technique, I was hoping for a more clinically based experience. I'm at that point where I really can't say no to the PI as they have vested trust in me and burning bridges is not professional unless like I have been accepted to study at a program and I have to leave. My luck in research hasn't really gone so great anyways, like I have tried getting my type of research (where I basically do research for a surgeon or something) but none of my tries have succeeded. It seems you either have to have great luck or know someone from the inside who has research scoop. The PI is a medical doctor and he owns his own lab. Since I am looking at the MD-PhD route, I can't help but feel like this is the type of research most of them do. In that case, I am quickly growing more fond of just attempting MD only.

 

[daenschl]

What a wonderful thread. Easy my favorite thread on SDN. I read it as a pre-med and am still reading it now as MSI.
@neusu have you decided on Academic vs private practice? I haven't really kept track of the timeline, but you must be about done with residency.

 

[Guero]

actually, over time, I have grown to get used to the mice, I tend to treat them as pets but as part of the study, they do get sick over time which makes me sad. The clinical part of this study is currently being conducted but it's someone else's assignment thus far and the project I've been put on is lab skill work. While I have no problem with this as it teaches me a really cool technique, I was hoping for a more clinically based experience. I'm at that point where I really can't say no to the PI as they have vested trust in me and burning bridges is not professional unless like I have been accepted to study at a program and I have to leave. My luck in research hasn't really gone so great anyways, like I have tried getting my type of research (where I basically do research for a surgeon or something) but none of my tries have succeeded. It seems you either have to have great luck or know someone from the inside who has research scoop. The PI is a medical doctor and he owns his own lab. Since I am looking at the MD-PhD route, I can't help but feel like this is the type of research most of them do. In that case, I am quickly growing more fond of just attempting MD only.

I'm sorry to hear you're unhappy with your research situation. Yes, the MD/PhD route is geared toward those wishing to conduct basic science research in the lab. While there are MD-only routes geared toward the same end (http://www.forums.studentdoctor.net/index.php?threads/Researching-with-MD.1154464/#post-16855184), if you're interested in clinical research, you can either go MD-only or pursue an MD/master's with extra training to help you conduct clinical and/or translational work (some info in the prior link). If you're interested in neurosurgery, your basic science work will help make you more competitive; but don't worry much about that until you're further along in med school. As you can probably tell, much like undergrad majors, many students change their minds about specialties as they move along in med school. Good luck!