Ask a neurosurgery resident anything

[neusu]

any rap or hip hop?

Every now and again it'll come in to the fray. For the most part, we try to be PC with our musical choices and not put anything that will be offensive or cause ear bleeding. The OR team is more than simply the surgical team. While I may like or be in the mood for a particular genre, my scrub technician and circulator may not be. Add in anesthesia and any other support staff (radiology techs, electrophysiologists, so on) who are a variety of ages and cultural backgrounds it can be a little difficult to come to a consensus solution. It'd be similar to taking them out to lunch or dinner: I may have a hankering for Vietnamese or Moroccan food while the nurses want Italian and salads, the med student wants cheap or free, and anesthesia wants Tex Mex. So we pick a top 40s or classic rock station/playlist and often stray away from the Gregorian Chant and Bluegrass Stations that someone may have suggested.

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[Guero]

Every now and again it'll come in to the fray. For the most part, we try to be PC with our musical choices and not put anything that will be offensive or cause ear bleeding. The OR team is more than simply the surgical team. While I may like or be in the mood for a particular genre, my scrub technician and circulator may not be. Add in anesthesia and any other support staff (radiology techs, electrophysiologists, so on) who are a variety of ages and cultural backgrounds it can be a little difficult to come to a consensus solution. It'd be similar to taking them out to lunch or dinner: I may have a hankering for Vietnamese or Moroccan food while the nurses want Italian and salads, the med student wants cheap or free, and anesthesia wants Tex Mex. So we pick a top 40s or classic rock station/playlist and often stray away from the Gregorian Chant and Bluegrass Stations that someone may have suggested.

For the record, med students are just happy to eat anything, especially anything free.

 

[neusu]

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

To be honest, I haven't really looked that much in to that. From what I've heard/read, OB and neurosurgery tend to be sued the most often and have the largest settlements.

Lawsuits are a part of medicine What we, and the obstetricians, do often has a significant, and lasting, impact on an individual and their ability to care for oneself. When a patient or family goes in to a procedure and the outcome is less than desirable, there often is a sense of hurt. We try to explain the risks of a procedure, but conceptually it is hard individuals to grasp statistics and how they apply to an individual.

 

[SonhosDaVida]

@neusu i was wondering if you could share the stats you had to get into med school? Do you have any advice for the MCAT/other portions of the application? thanks!

 

[splendanator]

I am an MD/PhD student interested in neurosurgery, and particularly in neuroprosthetics. I have a few questions that are somewhat related...

1. In an academic setting, do you believe that it would be feasible to divide clinical and protected research time after residency (i.e. 60:40 or so)?
2. You mentioned earlier that private practice neurosurgeons are somehow able to do research. Can you elaborate on this? Would one need to have an academic affiliation of sorts?
3. How common is it to be able to do an enfolded fellowship (i.e. functional) within residency?

Many thanks for your advice!

 

[Hamsterlope]

Thank you so much for this thread @neusu, your advice is literally life-altering for a lot of us and super important.

I'm an MS3 going through some serious existential unease right now. Like @splendanator, I'm also interested in neuroprosthetics and functional neurosurg. It's almost all I know, and I absolutely love it, from the patient population to the research to the change you can have in people's lives. I even love the high-pressure atmosphere in the OR, I love being in the OR doing procedures for hours at a time. But after a neurosurgery elective I took just now, I got scared s$%#less about the hours. My body breaks down if I don't sleep at least 7-7.5hrs every night and I get sick. I was depressed my daily schedule had nothing but the hospital in it. I had no time to cook, play music, read a book, talk to a friend, exercise. So I have this internal conflict in me raging.

Once you are an attending, is it actually possible to work 50hrs a week as a neurosurgeon, particularly in functional neurosurgery? Is there such a thing as a neurosurgery residency that is a little less brutal? This article also scared me quite a bit: http://www.biomedcentral.com/1472-6963/9/166. If you look at table 3, neurosurgeons report the lowest career satisfaction, and it's not even slightly the lowest, it's several standard deviations lower than the next lowest career satisfaction!

Having these feelings, I honestly feel weak and I hate it because I feel like I can't do what I love. I've looked into other fields with an open mind, and I think I might want to do them, but consistently, I gravitate back to neurosurgery as my favorite. If lifestyle is important to me (which it is), would it be wise I just let it go and move on? I feel like I'm fooling myself thinking I will actually be happy working long hours even if I love what I do. I fear it will begin to feel like a chore and wear on me and I'd lose what makes me passionate about it.

 

[mentalhypoxia]

How would an applicant with an MBA (part of an MD/MBA program) be received? I've heard mixed reactions by physicians, I was wondering what the perception of this is in the neurosurgical world.

 

[neusu]

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.

I am happy to hear you enjoyed this thread and are still reading it. I certainly enjoyed making it.

Like many things in medicine, we can create polarities in which to categorize groups of differences. That being said, reality is a bit of a spectrum therein. I suppose it would be obvious to create a formula to personally optimize the factors that come in to play for each job (salary arrangement, location, benefits, clinical time/RVU requirement, research time, productivity requirement, insurance, and so forth). If I figure out the magic mix or cheat codes to unlock unlimited everything, I'll let you know.

 

[deleted393595]

I am happy to hear you enjoyed this thread and are still reading it. I certainly enjoyed making it.

If I ever meet you in real life @neusu, I'm buying you a drink for this thread

 

[neusu]

For the record, med students are just happy to eat anything, especially anything free.

As a Jr resident I strongly felt that way! Needless to say, with experience came wisdom, and the incidence of eating free pastries or pizza had a direct correlation to my suit size.

Life has a way of narrowing our field of view when things become more intense. We don't see the forest through the trees so to say. Surgery, and surgical subspecialty training certainly are intense, rigorous, and demanding of time, intellect, resilience, and fortitude. When I was an M3 on general surgery they had a saying, and I'm sure someone can correct me, but something to the tune of, "Eat when you can, sleep when you can, **** when you can, and don't **** with the liver." To paraphrase, you never know if and/or when you will have time to do these normal bodily functions so take the opportunity when it presents itself. As a young doctor, drinking the Kool-Aid and joining the espirit de corps is perhaps another coping mechanism to the onslaught of new patients, hectic hours, and lack of availability of or desire for healthier options. I won't go so far as to say it is imperative to maintain one's individuality and identity throughout the process, certainly there is something to be said for going in to the meat-grinder of residency on one end a doe-eyed medical student and coming out the other Grade-A certified attending. What I mean, however, is if small things like eating healthier and exercising or practicing your Bach or Liszt on the piano help you keep your sanity, by all means, keep at it. That isn't to say, however, you'll keep your 6-pack, be running marathons, or playing at Carnegie Hall during residency.

 

[Guero]

As a Jr resident I strongly felt that way! Needless to say, with experience came wisdom, and the incidence of eating free pastries or pizza had a direct correlation to my suit size.

Life has a way of narrowing our field of view when things become more intense. We don't see the forest through the trees so to say. Surgery, and surgical subspecialty training certainly are intense, rigorous, and demanding of time, intellect, resilience, and fortitude. When I was an M3 on general surgery they had a saying, and I'm sure someone can correct me, but something to the tune of, "Eat when you can, sleep when you can, **** when you can, and don't **** with the liver." To paraphrase, you never know if and/or when you will have time to do these normal bodily functions so take the opportunity when it presents itself. As a young doctor, drinking the Kool-Aid and joining the espirit de corps is perhaps another coping mechanism to the onslaught of new patients, hectic hours, and lack of availability of or desire for healthier options. I won't go so far as to say it is imperative to maintain one's individuality and identity throughout the process, certainly there is something to be said for going in to the meat-grinder of residency on one end a doe-eyed medical student and coming out the other Grade-A certified attending. What I mean, however, is if small things like eating healthier and exercising or practicing your Bach or Liszt on the piano help you keep your sanity, by all means, keep at it. That isn't to say, however, you'll keep your 6-pack, be running marathons, or playing at Carnegie Hall during residency.

Well said, as always my friend. About 30 pounds later, the grind of an ending M2 year and Step-prep is exacerbating my ever-growing formal wear size. :/ I keep telling myself and have tried valliantly to command myself to get back to the gym, to no avail. Hope you're holding up well in residency!

 

[neusu]

@neusu i was wondering if you could share the stats you had to get into med school? Do you have any advice for the MCAT/other portions of the application? thanks!

I'd have to look through my files to find this information exactly. Also, the MCAT itself has changed, though I'm not sure if the scoring system is any different.

Call me idealistic or kookie, but I actually like learning what things are, how they got that way, why they work. This certainly made learning a lot more fun, and easier, than it could have been. Thus, I'll often find myself randomly thinking about pahways or physics equations, etc. and it makes me happy to understand these processes. It wasn't always easy, especially with structured learning and so forth, if I didn't have that "aha" moment about a concept I'd have to brute force it for the test. I suppose, what I'm getting at is, medicine is a scientific field. Having an intrinsic interest and understanding in how/why things work, how to fix problems, or improve upon that basis is a fundamental basis for our practice. Pursuing your studies, and actually enjoying yourself, predisposes you to understanding it better and pursuing opportunities for growth. The long and short of it, is, if you like what you do, you do what you like, and naturally build your application with better scores and more experience.

 

[neusu]

I am an MD/PhD student interested in neurosurgery, and particularly in neuroprosthetics. I have a few questions that are somewhat related...

1. In an academic setting, do you believe that it would be feasible to divide clinical and protected research time after residency (i.e. 60:40 or so)?
2. You mentioned earlier that private practice neurosurgeons are somehow able to do research. Can you elaborate on this? Would one need to have an academic affiliation of sorts?
3. How common is it to be able to do an enfolded fellowship (i.e. functional) within residency?

Many thanks for your advice!

1) It is absolutely possible. The issue with this, most often, comes from salary disputes. Arbitrarily, let's say a full professor PhD makes $200,000 and a neurosurgeon makes $500,000. The hospital wants you to operate, the university wants you to do research and get grant money. Each want to pay you as little as they can to get the most out of you. Namely, if you split time 50:50, you won't get paid 50:50, or $350,000.

2) Anyone in the world can do research, no affiliation necessary. Doctors in general have been good about innovating within medicine and sharing their ideas with one another. A surgeon who writes up his experience with a disease or new surgical technique is doing research. Being paid to do research, on the other hand, is a different story. There certainly have been many examples of private practice surgeons who thought highly of research, to the point that they used their clinical reputation to mortgage a research institution: Mayo, Cleveland Clinic, etc.

3) Enfolded fellowships used to be very, very common. For a period, recently, they were less common. Now, however, the ABNS is realizing the competition and making a framework for enfolded fellowships. Functional, included.

 

[MarioKart]

Hey neusu thanks for the thread! It's awesome. I have 3 questions:

1.) were there any other specialty choices that you considered?

2.) what are neurosurgery hours really like? I understand that's it's not known to be a lifestyle specialty, but as a resident and, as a future attending, what would a typical workweek (in terms of hours) look like?

3.) what was the number one factor that drove you towards neurosurgery the most???

Apologies if these questions have already been asked! Thanks so much, I appreciate this

 

[neusu]

Thank you so much for this thread @neusu, your advice is literally life-altering for a lot of us and super important.

I'm an MS3 going through some serious existential unease right now. Like @splendanator, I'm also interested in neuroprosthetics and functional neurosurg. It's almost all I know, and I absolutely love it, from the patient population to the research to the change you can have in people's lives. I even love the high-pressure atmosphere in the OR, I love being in the OR doing procedures for hours at a time. But after a neurosurgery elective I took just now, I got scared s$%#less about the hours. My body breaks down if I don't sleep at least 7-7.5hrs every night and I get sick. I was depressed my daily schedule had nothing but the hospital in it. I had no time to cook, play music, read a book, talk to a friend, exercise. So I have this internal conflict in me raging.

Once you are an attending, is it actually possible to work 50hrs a week as a neurosurgeon, particularly in functional neurosurgery? Is there such a thing as a neurosurgery residency that is a little less brutal? This article also scared me quite a bit: http://www.biomedcentral.com/1472-6963/9/166. If you look at table 3, neurosurgeons report the lowest career satisfaction, and it's not even slightly the lowest, it's several standard deviations lower than the next lowest career satisfaction!

Having these feelings, I honestly feel weak and I hate it because I feel like I can't do what I love. I've looked into other fields with an open mind, and I think I might want to do them, but consistently, I gravitate back to neurosurgery as my favorite. If lifestyle is important to me (which it is), would it be wise I just let it go and move on? I feel like I'm fooling myself thinking I will actually be happy working long hours even if I love what I do. I fear it will begin to feel like a chore and wear on me and I'd lose what makes me passionate about it.

You're welcome, I have enjoyed making this thread, and hopefully you guys get something out of it. My goal all along has been honesty and transparency to help people interested in neurosurgery to see if it's for them as well as those who aren't to understand what we do and how we can work together.

Those are all great questions. To be honest, you know yourself far more than anyone else. Is the brutality of a neurosurgery residency something you can tough out, for 7-years, to get where you want?

Functional neurosurgery and neuroprosthetics fascinate me. We're only in the infancy of the field, and I suspect in the next 100 years it will be a civilization game changer. There are innumerable parties involved, and the neurosurgeon is really only the technician in placing the hardware (according to the PhD types anyhow).

I looked back over this thread and saw I indicated I averaged 4-6 hours/sleep/night. Over the course of 7 years, say a 3-hour-a-night deficit, it would take 21-years to make it up if you slept an extra hour for the rest of your life after residency. Now for me, it's something I knew I wanted. The blood, guts, brain, gore, 72-hour trauma-rauma. Give me all of it.

What I'm saying is, there are many paths that lead to being satisfied in functional neurosurgery. We operate and put the hardware in, neurologists follow the patients long term. PhDs and engineers develop the technology. Look at what facet interests you most and what ways you can get there. Certainly, neurosurgery residency can get you anywhere on the spectrum. Only neurosurgery residency can get you to placing the hardware.

 

[neusu]

How would an applicant with an MBA (part of an MD/MBA program) be received? I've heard mixed reactions by physicians, I was wondering what the perception of this is in the neurosurgical world.

I can't think of a reason this would be seen as either a positive or negative.

All the neurosurgery program wants to know is whether 1) you can handle the job 2) they want to work with you. A distant 3) is whether or not you'll go on to make a name for yourself.

 

[neusu]

If I ever meet you in real life @neusu, I'm buying you a drink for this thread

Cheers!

 

[neusu]

Well said, as always my friend. About 30 pounds later, the grind of an ending M2 year and Step-prep is exacerbating my ever-growing formal wear size. :/ I keep telling myself and have tried valliantly to command myself to get back to the gym, to no avail. Hope you're holding up well in residency!

Doing lovely. Sorry to hear about your recent unexpected expansion! Give it time my friend, you will find you equilibrate. If life ever feels too daunting, laugh at yourself, take a step back from the situation, reassess and move on. You'll do splendidly, I am sure!

 

[neusu]

Hey neusu thanks for the thread! It's awesome. I have 3 questions:

1.) were there any other specialty choices that you considered?

2.) what are neurosurgery hours really like? I understand that's it's not known to be a lifestyle specialty, but as a resident and, as a future attending, what would a typical workweek (in terms of hours) look like?

3.) what was the number one factor that drove you towards neurosurgery the most???

Apologies if these questions have already been asked! Thanks so much, I appreciate this

1) Not really. I went through med school in a rule-out phase. I knew I wanted to do neurosurgery but wanted to make sure there wasn't something else I wanted more.

2) Hours vary by location. 80/week is pretty standard. Attendings seem to have better lifestyle than residents

3) I think the fact that I get to do surgery on the part of the body who makes us who we are is amazing. That really drove me in to pursuing the field. Plus, I'm not a fan of bowel contents or secretions so gen surg/ent were out. Any field that allows a t-year or medicine internship is hardly surgery so count out optho urology (j/k guys!).

 

[Gurby]

Hi Neusu, thanks for the awesome thread! I have a serious question...

I have a really wimpy bladder. If I have coffee, I end up needing to pee every 30 minutes for a few hours. I can do caffeine pills and restrict fluid intake and be okay, but hydration is also important for mental alertness. Knowing that neuro cases can often be very long, do you pay special attention to your fluid and caffeine intake? Do you know any older surgeons with BPH and things like that? How do they manage?

 

[neurosur]

Hello, @neusu

I've recently stumbled upon this thread and to say the least, I've been staying up late reading it, so thank you for all the information that you're providing on here, and forgive me if some of the questions are repetitive (I'm still on page 15). I'm going to be graduating high school next year, and I had some questions about undergrad, med school, and residency.

1) I realize that it's a bit late, but do you know of any opportunities that I would be able to get involved in with the neurosurgeons at my local hospital or college (other than shadowing; I'll be contacting one to schedule shadowing for a day or two)?

2) As part of your undergrad and med school research opportunities (you mentioned that you were cleaning glassware at first), what sort of research were focused on? Or did it range under the neurosurgery/neuroscience category?

3) You talked about your daily schedule while you were a resident. What about while you were an undergrad and in med school? How many hours and how often would you study per day? What methods of studying proved to be helpful in memorizing and understanding medical terms and just the material of the class in general?

4) I understand that though your med school years, the first two were devoted to basic science instruction and education, and the latter two were clinical. What exactly did you mean when you said that you were on a clinical rotation? Does that refer to trying out the different services?

5) For your internship year, is that the year after med school but before residency?

6) Are you matched to the same hospital/facility/place for both your internship year and residency years?

7) Do you have any experience in trauma neurosurgery? If so, could you please explain?

Thanks in advance, and I hope you've gotten to relax for the holidays!

 

[Rifampicin]

Hello, Neusu! 5th (out of 6) year medical student here. I have a couple of questions about neurosurgery, so here it goes..

1. I've always loved oncology and neuroscience, and I'm strongly considering neurosurgery. My hospital is the national referral centre in my country and our neurosurgery department treat as many as 120 primary gliomas annually. Do you think these numbers are high enough or should I pursue residency training in a developed country (i.e., EU, US, Japan) to look for more volumes?
... As a side note, research is practically non-existent here (being poor Asian country and all) and I would also like to have one or two research years...
What do you think?

2. As a resident and as an attending, how often do you operate at your institution in a week? Can you please elaborate what cases do you usually operate on (i.e., what percentage of surgeries in your residency/current practice are spine, tumors, trauma, etc.)?

Thanks

 

[Gauss44]

Do you have any advice for students who want to shadow a neurosurgeon? What is a good way to go about asking?

 

[Mjolner]

Do you have any advice for students who want to shadow a neurosurgeon? What is a good way to go about asking?

I'd start with A/S/L

 

[Dr. Retractor]

Do you have any advice for students who want to shadow a neurosurgeon? What is a good way to go about asking?

Show up to their office dressed nicely (business casual) and hand the receptionist or whoever you can talk to that will see the surgeon a resume and let them know that you're a premed interested in shadowing. Works 99% of the time and if it doesn't you'll at least get a phone call/email telling you that the surgeon doesn't want you to shadow, possibly due to regulatory hoops or whatever. Cold-calling/emailing has a pretty low success rate, at least in my experience.

 

[Guero]

Show up to their office dressed nicely (business casual) and hand the receptionist or whoever you can talk to that will see the surgeon a resume and let them know that you're a premed interested in shadowing. Works 99% of the time and if it doesn't you'll at least get a phone call/email telling you that the surgeon doesn't want you to shadow, possibly due to regulatory hoops or whatever. Cold-calling/emailing has a pretty low success rate, at least in my experience.

Emailing works just as well if you keep the email to less than 3 sentences and attach your CV/resume, at least in my experience. I recommend trying both and following up if you don't hear anything within a week (which shows serious intent and initiative). Good luck!

 

[Hamsterlope]

Thank you so much @neusu! I've been checking this thread periodically over the last few months and it was well worth the wait for the expert advice. I may be some random person, but for this random guy, your insights and stories have meant a lot.

You're welcome, I have enjoyed making this thread, and hopefully you guys get something out of it. My goal all along has been honesty and transparency to help people interested in neurosurgery to see if it's for them as well as those who aren't to understand what we do and how we can work together.

Those are all great questions. To be honest, you know yourself far more than anyone else. Is the brutality of a neurosurgery residency something you can tough out, for 7-years, to get where you want?

Functional neurosurgery and neuroprosthetics fascinate me. We're only in the infancy of the field, and I suspect in the next 100 years it will be a civilization game changer. There are innumerable parties involved, and the neurosurgeon is really only the technician in placing the hardware (according to the PhD types anyhow).

I looked back over this thread and saw I indicated I averaged 4-6 hours/sleep/night. Over the course of 7 years, say a 3-hour-a-night deficit, it would take 21-years to make it up if you slept an extra hour for the rest of your life after residency. Now for me, it's something I knew I wanted. The blood, guts, brain, gore, 72-hour trauma-rauma. Give me all of it.

What I'm saying is, there are many paths that lead to being satisfied in functional neurosurgery. We operate and put the hardware in, neurologists follow the patients long term. PhDs and engineers develop the technology. Look at what facet interests you most and what ways you can get there. Certainly, neurosurgery residency can get you anywhere on the spectrum. Only neurosurgery residency can get you to placing the hardware.

 

[barsoum.michael]

Do you have any advice for students who want to shadow a neurosurgeon? What is a good way to go about asking?

I started shadowing a neurosurgeon at the age of 17 by emailing tons of surgeons until 1 responded.

 

[neusu]

Hi Neusu, thanks for the awesome thread! I have a serious question...

I have a really wimpy bladder. If I have coffee, I end up needing to pee every 30 minutes for a few hours. I can do caffeine pills and restrict fluid intake and be okay, but hydration is also important for mental alertness. Knowing that neuro cases can often be very long, do you pay special attention to your fluid and caffeine intake? Do you know any older surgeons with BPH and things like that? How do they manage?

I tend to have to go unless I'm focused on something, and then I have a bladder of steel. During the day, I try to stay hydrated. As you can imagine, dry OR air can be dehydrating. It's always a balance between taking fluids on and needing to let them go. Likewise, caffeine can affect this. Most residents I know drink caffeine of some sort (e.g. coffee, energy drinks, red bull). I also know some residents who just take caffeine pills.

If you need to go, you're an adult. At a convenient time in the case announce you are scrubbing out to use the restroom. Pick your gloves and gown and either open or have the circulator open them, so when you return you can slide back in. If you don't know the case, you can always ask "Would now be an ok time for a bathroom break?" When you're involved in the case, leaving at an inopportune time can actually hurt the progress of the case. Even as a student, your role is to assist the surgeon.

 

[Guero]

Pssst, @neusu, here's a nudge to sincerely say that I hope these mid-level years are going well for ya. Hope to run into you once I finish cores and start the visiting rotations. If not then, perhaps on the interview trail. I'll shoot you a pm around that time so I can buy you coffee between a case to thank you for all of your help and encouragement over the past few years.

 

[Psai]

Props to the neurosurgery residents who seem to be the best at teaching students and getting them involved

 

[neusu]

Hello, @neusu

I've recently stumbled upon this thread and to say the least, I've been staying up late reading it, so thank you for all the information that you're providing on here, and forgive me if some of the questions are repetitive (I'm still on page 15). I'm going to be graduating high school next year, and I had some questions about undergrad, med school, and residency.

1) I realize that it's a bit late, but do you know of any opportunities that I would be able to get involved in with the neurosurgeons at my local hospital or college (other than shadowing; I'll be contacting one to schedule shadowing for a day or two)?

2) As part of your undergrad and med school research opportunities (you mentioned that you were cleaning glassware at first), what sort of research were focused on? Or did it range under the neurosurgery/neuroscience category?

3) You talked about your daily schedule while you were a resident. What about while you were an undergrad and in med school? How many hours and how often would you study per day? What methods of studying proved to be helpful in memorizing and understanding medical terms and just the material of the class in general?

4) I understand that though your med school years, the first two were devoted to basic science instruction and education, and the latter two were clinical. What exactly did you mean when you said that you were on a clinical rotation? Does that refer to trying out the different services?

5) For your internship year, is that the year after med school but before residency?

6) Are you matched to the same hospital/facility/place for both your internship year and residency years?

7) Do you have any experience in trauma neurosurgery? If so, could you please explain?

Thanks in advance, and I hope you've gotten to relax for the holidays!

1) Never too late! Call the office or shoot them an email and let them know you are a motivated, young, student interested in learning about the field and opportunities. I routinely have M1/M2, undergrads, and high schoolers (or their family members I work with) contact me for shadowing or research opportunities.

2) I did start with cleaning glassware. That being said, I worked in a neuroscience research lab and tried to latch on to a project as soon as I could!

3) I wasn't a very good undergrad. I spent too much time in the lab and not enough time "studying." That being said, I find for me, just reading through everything a time or two, followed by focused memorization, is best.

4) The 3rd year of medical school, regardless of where you go in the US, is devoted to trying out different specialties (internal medicine, surgery, obstetrics/gynecology, pediatrics, psychiatry, family medicine).

5) For neurosurgery, the intern year is a part of residency. Historically, it had been separate, but the ABNS decided it needed to be included

6) Currently, yes. This was not always the case.

7) Yes. Trauma is a part of residency. My program had a busy trauma center so I have extensive experience managing operative and non-operative traumatic brain and spine injury.

 

[Guero]

. . .

2) I did start with cleaning glassware. That being said, I worked in a neuroscience research lab and tried to latch on to a project as soon as I could!
. . .

To the OP of this answer, I highlight @neusu's response to make a very important point. Neusu's experience is quite common.

Here's mine: The PI I approached as a post-bacc refused my request to join his lab three times despite the reference of his former lab student, my undergraduate Neuroscience director and professor at the time. The lab manager recognized this and stopped me on my way out after the third time and introduced me to the PI's MSTP student (NIH funded MD/PhD program). He and I sat down and discussed my own MSTP intents. He spoke to the PI and convinced him to allow me to apprentice under him. This PI turned out to be an eminent leader in his neurophysio field and wrote me the strongest letters I've ever received. That same letter led me to my current career as an HHMI funded student physician scientist (non-PhD).

I share this to convey the utter import of persistence and recognizing that uncertainty in your current efforts may very well lead you to success. Never discount yourself or your pursuits. You'll surprise yourself when you're motivated and among the serendipitous "right" people. I wish you the best.

 

[neusu]

Hello, Neusu! 5th (out of 6) year medical student here. I have a couple of questions about neurosurgery, so here it goes..

1. I've always loved oncology and neuroscience, and I'm strongly considering neurosurgery. My hospital is the national referral centre in my country and our neurosurgery department treat as many as 120 primary gliomas annually. Do you think these numbers are high enough or should I pursue residency training in a developed country (i.e., EU, US, Japan) to look for more volumes?
... As a side note, research is practically non-existent here (being poor Asian country and all) and I would also like to have one or two research years...
What do you think?

2. As a resident and as an attending, how often do you operate at your institution in a week? Can you please elaborate what cases do you usually operate on (i.e., what percentage of surgeries in your residency/current practice are spine, tumors, trauma, etc.)?

Thanks

1. Does your hospital have a neurosurgery training program? Being a referral center does help increase the volume of things that naturally occur less frequently. It would be tough to tell though, if 120 is sufficient. How many other residents are sharing these cases? How is the neuro/rad-onc at your center? If research is important to you, it might be worth spending a couple years at a center in another country that has a strong research program. Alternatively, attend a meeting or two and get some ideas on how you can structure a program in your center. A single center/national experience in a 3rd world country is an important study to help understand the global presentation, management, and impact of the diseases we treat.

2. As a resident, we typically operated every day of the week. We had designated didactics/clinics, but would have to cover cases as well. My program is probably 60% spine and 40% cranial. Operative trauma tends to be relatively uncommon, but can come in waves. I've had stretches where I only had 2 emergency craniotomies in a week or 7 in 24 hours. Same with spine trauma. The vast majority is non-operative, but occasionally we'll have them stacked up and be operating constantly.

 

[leonardoson]

What's your favorite ice cream?

 

[neusu]

Do you have any advice for students who want to shadow a neurosurgeon? What is a good way to go about asking?

I think it's been covered by others. In any case, if you have any personal contacts that can directly put you in touch that's best. Next, either email the neurosurgeon and/or his secretary and ask. A phone call works as well. Finally, as mentioned, just showing up in the office is a possibility, but I personally have never heard of this.

Most are receptive to students interested in learning about what we do and are willing to help facilitate a learning experience. You may have to do a bit of leg-work yourself, e.g. credentialling/training etc to work in the hospital or clinic. Back in the good old days, you could just show up with the surgeon or meet them wherever. Anymore, it's a bit more regulated.

 

[fatkitty]

Currently on page 16, slowly going through this entire thread and definitely learning a lot.

It's been asked long before but do you have any thoughts about DO's in neurosurgery? How do you think the AOA/ACGME merger will affect residency spots? I have a feeling it may be more difficult for DO's to match former AOA residencies because MD are now able to apply/match into them. Some think there will be an anti-MD mentality among program directors at the former AOA locations but I have a hard time believing that...

 

[neusu]

Thank you so much @neusu! I've been checking this thread periodically over the last few months and it was well worth the wait for the expert advice. I may be some random person, but for this random guy, your insights and stories have meant a lot.

You're welcome, happy to help!

 

[neusu]

Props to the neurosurgery residents who seem to be the best at teaching students and getting them involved

I always tell the students that I have on service that you get out of it what you put in. I'm happy to teach what I know and spend as much time explaining concepts or management. It is a two way street though, the students who get the most out of working with me read before cases and ask insightful questions or practice the things they can help with like suturing, suctioning, tying knots.

 

[neusu]

What's your favorite ice cream?

Never was much of a dessert person. I think plain old vanilla might be it!

 

[Aphiah]

Hi @neusu

How much does the medical school you go to impact your neurosurgery residency placement (if there is any impact at all)?

 

[acslater99]

Do you have a signature "saying" or "line" you like to tell your surgical team before the surgery starts? Perhaps for good luck?

 

[neusu]

Currently on page 16, slowly going through this entire thread and definitely learning a lot.

It's been asked long before but do you have any thoughts about DO's in neurosurgery? How do you think the AOA/ACGME merger will affect residency spots? I have a feeling it may be more difficult for DO's to match former AOA residencies because MD are now able to apply/match into them. Some think there will be an anti-MD mentality among program directors at the former AOA locations but I have a hard time believing that...

All of the DO folks I have worked with thus far have been great. With the merger, I suspect, in the future the difference between MD and DO in people's minds will become less and less. I can't speak for the AOA residencies, but programs select residents based on characteristics they choose. One program may have had a good experience with applicants from one school while another had the opposite. We will have to wait to see.

 

[aalamruad]

@neusu Is there a big difference between the bread and butter cases of adult neurosurgery compared to peds neurosurgery? And are there enough peds neurosurgeons to handle all the peds cases, or are general neurosurgeons without the peds fellowship ever eligible to handle peds cases?

 

[The Buff OP]

Hi neusu!

 

[neusu]

Sorry for a "What Are My Chances" post, but here goes!

I'm an MS3 attending a US medical school who is interested in neurosurgery. I initially wanted to do ortho spine but changed my mind. I obtained a PhD prior to medical school. My step 1 was in the 240s. I've gotten Honors in my FM, IM, and surgery rotations thus far. I'm first author on a book chapter in an ortho spine textbook, and am currently working on an ortho spine research project.

1.) Do I have a chance of matching into neurosurgery?

2.) Should I try to do a neurosurgery focused research project, or will my current research suffice?

1) Yes. Obviously I could give you a better idea if I knew more. Feel free to PM me your CV etc and I can try to give you an honest critique

2) Yes, the more neurosurgery relevant the better. Other clinical specialties are fine, ortho spine is similar enough that I suspect most folks won't discount it.

 

[neusu]

Hi @neusu

How much does the medical school you go to impact your neurosurgery residency placement (if there is any impact at all)?

When I would go to interview dinners, I'd often make an analogy of residency to being like speed dating. To summarize, everyone has different preferences, but we can make some generalizations.

The enemy you know is better than the enemy you don't. Programs often have a history with students from certain schools. Likewise, schools that produce a lot of neurosurgery residents have a lot of clout out there.

Being in the family has its benefits. Medical schools that have a residency program have a chairman and program director who can make calls on your behalf. You can get involved in research earlier in medical school, and get to understand if it's something you want to do sooner in medical school than those at schools without a department.

Intangibles can make or break the game. If you are miserable at best medical school because of cultural, family, climate, or environmental issues it certainly will affect your residency placement.

So, my personal formula for advice on where to go is: go to the cheapest, best school you get in to that has a neurosurgery program and will make you happy.

 

[Aphiah]

When I would go to interview dinners, I'd often make an analogy of residency to being like speed dating. To summarize, everyone has different preferences, but we can make some generalizations.

The enemy you know is better than the enemy you don't. Programs often have a history with students from certain schools. Likewise, schools that produce a lot of neurosurgery residents have a lot of clout out there.

Being in the family has its benefits. Medical schools that have a residency program have a chairman and program director who can make calls on your behalf. You can get involved in research earlier in medical school, and get to understand if it's something you want to do sooner in medical school than those at schools without a department.

Intangibles can make or break the game. If you are miserable at best medical school because of cultural, family, climate, or environmental issues it certainly will affect your residency placement.

So, my personal formula for advice on where to go is: go to the cheapest, best school you get in to that has a neurosurgery program and will make you happy.

Thanks for the response, neusu. These are things I definitely will keep in mind.

 

[neusu]

Do you have a signature "saying" or "line" you like to tell your surgical team before the surgery starts? Perhaps for good luck?

I'd thought about it in the past, but never really went with anything. I'm sure you'll laugh about this, but it's a bit of insight in to how much of a nerd I am. In 1991/1992, the Pittsburgh Penguins won the Stanley Cup back to back and I was in love with them. Their coach, Bob Johnson, had a saying, it's 'A Great Day For Hockey.' He ended up having a brain aneurysm and dying of a brain tumor in 1991. Anyway, my was going to be, it's 'A Great Day For Surgery.'

 

[Dr. Retractor]

Is it better to do research with a neurosurgeon with a "bigger name" (publishes in more high IF journals, higher academic rank, top med school/residency alumni) whose research you're kind interested in or a smaller name whose research you're very interested in?

My thought initially was to go with the bigger name because research interests are fluid and because I did research I was only kind of interested in in undergrad and was still very productive. OTOH I am not sure how important the area of your research is for matching and if a not-super-interested attitude would affect my ability to publish given the rigors of med school curriculum.