Ask a neurosurgery resident anything

[Guero]

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.

FWIW, I'd like to offer a brief reply while we wait for neusu: I'd recommend that you choose based on potential for productivity (author/coauthor of pub/poster) based on discussions with the PI regarding your involvement and how much you'll gain in terms of methods/design experience. Those are the primary factors that'll come up during interviews: what you did, accomplished, and gained. The name and +\- interest are secondary. GL


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[Dr. Retractor]

FWIW, I'd like to offer a brief reply while we wait for neusu: I'd recommend that you choose based on potential for productivity (author/coauthor of pub/poster) based on discussions with the PI regarding your involvement and how much you'll gain in terms of methods/design experience. Those are the primary factors that'll come up during interviews: what you did, accomplished, and gained. The name and +\- interest are secondary. GL


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Thanks for the answer, I hadn't considered that factor. I just looked and it seems like both of them publish with similar frequency and there are students that are part of almost all of the publications. Although it's probably better to discuss the possibility of co-authorship with the physicians first since I'm not sure what year or degree the students are in.

But if I understood what you said, as a general rule more output is better than the bigger name LOR? So I guess the LORs are more important from rotations and sub-i's?

 

[Guero]

Thanks for the answer, I hadn't considered that factor. I just looked and it seems like both of them publish with similar frequency and there are students that are part of almost all of the publications. Although it's probably better to discuss the possibility of co-authorship with the physicians first since I'm not sure what year or degree the students are in.

But if I understood what you said, as a general rule more output is better than the bigger name LOR? So I guess the LORs are more important from rotations and sub-i's?

Anytime! I love research and do my best to help spread what I've learned; we need more brave souls to forge through the current wane phase of waxing and waning funding.

As for the clarification, yes, your productivity and gains in skill outweigh the name, but not the LOR. The LOR, regardless of name, will reinforce and delineate your productivity and gains from the eye of an experienced scientist. Your rotation and sub-i LORs are all equal and most important, though. The research will bolster your CV in preparation to apply to top tier, research heavy residency programs. But it's not necessarily as essential unless you're targeting a physician scientist residency program. Much like neusu already elaborated earlier, despite an inherent edge to having big names on your transcripts and the letter head of your LORs, the results are key, not the name, just like it was for your MCAT and school during AMCAS. A 35 MCAT (dating myself here) from an unknown school will land you more interviews than a 28 from Harvard, hands-down. Feel free to PM me if you need anything, don't wanna high jack the thread.


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[neusu]

@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?

Bread and butter adult cases tend to be non-complex/degenerative spine and smaller, non-eloquent brain tumors. Pediatric bread and butter is more chiari decompression, shunt placement or revision, tethered cord/spinal dysraphism, and tumor. For the most part, the pedi cases go to the pedi surgeons at larger centers. I can't speak for the places in the periphery, but I suspect they would refer it out.

 

[neusu]

Hi neusu!

Hey bud, long time!

 

[neusu]

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.

I think as @Guero mentioned, pick the lab that will get you published. When it comes around to application/interview time, not having it on your CV (e.g. no publication from the work) is almost the same as not doing it at all. Labs that are led by big name people tend to be rather productive, thus the big name. Regardless, a group that has something you think you are interested in. In my limited experience, the guys just starting out are very hungry, have great ideas, and great to work with. That being said, there is often a lag time for a lab that is just starting out to get enough of a momentum and data to put out a major paper or get a big grant.

 

[Dr. Retractor]

I think as @Guero mentioned, pick the lab that will get you published. When it comes around to application/interview time, not having it on your CV (e.g. no publication from the work) is almost the same as not doing it at all. Labs that are led by big name people tend to be rather productive, thus the big name. Regardless, a group that has something you think you are interested in. In my limited experience, the guys just starting out are very hungry, have great ideas, and great to work with. That being said, there is often a lag time for a lab that is just starting out to get enough of a momentum and data to put out a major paper or get a big grant.

Thank you!

 

[The Buff OP]

Hey bud, long time!

Sure has been a long time, man. I'm guessing you are your last months of residency? I'm pretty sure you got tired of doing this thread lol.

 

[neusu]

I will be applying to MD and MD PhD applications and to be honest, I think my app would be stronger for MSTP programs (because I have a lot more research experience than clinical) but at this point, I would really be happy either way. I have hospital volunteering and limited shadowing experience but I am thinking of shadowing a dr for the next couple of months and potentially asking her for a LOR. Do you think it would be worth it (or does it come off as being overly superficial)? My other letters are great (or so I'm told).
He also does research in something that I would be interested in as well...

Demonstrating understanding of and interest in the clinical practice of medicine is important, regardless of program. Even without the benefit of gaining a letter, shadowing a doctor in who's field you have interest would be a useful experience. Most physicians are understanding of the needs of students regarding applications. Just show up, be cordial and polite, show interest, and things should work out.

 

[neusu]

Sure has been a long time, man. I'm guessing you are your last months of residency? I'm pretty sure you got tired of doing this thread lol.

Not at all, it's always nice talking to the folks who will be the future of medicine. I just hope we can attract some to carry on neurosurgery!

 

[Morgan_2018]

Do you have any suggestions for a high school student interested in this career path? Do you know if it's possible to shadow someone at this age (I understand that shadowing a surgeon is out of the question, but is there any other specialties that may be interesting to someone who wants to go down this path)?

 

[Dr. Retractor]

Do you have any suggestions for a high school student interested in this career path? Do you know if it's possible to shadow someone at this age (I understand that shadowing a surgeon is out of the question, but is there any other specialties that may be interesting to someone who wants to go down this path)?

It depends on how old you are but you can definitely shadow a surgeon. Your parents might need to sign some papers if you're <18.

 

[The Buff OP]

Not at all, it's always nice talking to the folks who will be the future of medicine. I just hope we can attract some to carry on neurosurgery!

Sure....

If neurosurgery would be cut down to 5 years, then I would give it some thought.

Neurosurgery is a really cool specialty. Even in EMS they are seen as the gods lol.

 

[neusu]

Do you have any suggestions for a high school student interested in this career path? Do you know if it's possible to shadow someone at this age (I understand that shadowing a surgeon is out of the question, but is there any other specialties that may be interesting to someone who wants to go down this path)?

First and foremost, focus on yourself. Learn what makes you happy. Try to understand how you learn, what techniques work for you and which do not. Aim to do the best you possibly can in the academic realm (e.g. grades, scores, etc.). Regardless of what you would like to do in life, those tend to be used as a measuring stick. Yes, practical experience and so forth counts too, but don't handicap yourself.

It is absolutely possible to shadow a surgeon. As mentioned, you may need to fill out some paperwork on privacy and take a course on how to behave in the hospital. The other thing you could do to start adding to your application is volunteering. The hospital is a great place for this, but so are many other settings. Good luck!

 

[IlyaR]

To be a competitive applicant does one need to have neuro specific research? I did an ortho observership and really liked it, so I'm gonna start ortho research when I start school this fall, but wondering if that would that research would be a "red flag" if I ever decide that neuro is where I want to be. Thanks!


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[The Buff OP]

How much do you squat?

On a serious note, are squats bad for you? Over the years I have noticed this lump that formed by my T1/T2.

 

[neusu]

Sure....

If neurosurgery would be cut down to 5 years, then I would give it some thought.

Neurosurgery is a really cool specialty. Even in EMS they are seen as the gods lol.

There has been some talk to reduce general neurosurgery to 5 years, and then have fellowship for more specialized training.

 

[The Buff OP]

There has been some talk to reduce general neurosurgery to 5 years, and then have fellowship for more specialized training.

That would be cool.

Do you feel like 7 years is just right or 5 years is enough?

 

[tantacles]

It depends on how old you are but you can definitely shadow a surgeon. Your parents might need to sign some papers if you're <18.

ftfy. Remember that the alligator eats the bigger number!

 

[neusu]

In your opinion/experience, is it doable/realistic for a neurosurgery resident to have a baby during residency? Specifically if the spouse is also a resident (but in a different/less time-intensive residency)?

Much of this is determined by how well the individual and family accommodate the changes in their lives that happen when a baby arrives. I know of both residents themselves, and residents married to residents, who had babies during residency. As mentioned in other threads regarding neurosurgery specifically, most programs have lighter rotations at times including electives and research. While a resident can have a baby at any point in residency, there are no rules against it, nor should there be. Many plan around these lighter rotations to make life easier for themselves, their families, and their co-residents.

 

[fancymylotus]

Just saying hi @neusu


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[Guero]

ftfy. Remember that the alligator eats the bigger number!

Fantantacles is getting feisty.


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[tantacles]

Fantantacles is getting feisty.


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I have class, sass, and a whole lot of ass.


Large dogs

 

[Guero]

I have class, sass, and a whole lot of ass.


Large dogs

I totes should've waited to see if your school's adcom would've interviewed me back then just so I could've chilled with you. Hope you're doing well, hon.

//derailment

Sorry for the temp hijack @neusu Carry on.


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[neusu]

To be a competitive applicant does one need to have neuro specific research? I did an ortho observership and really liked it, so I'm gonna start ortho research when I start school this fall, but wondering if that would that research would be a "red flag" if I ever decide that neuro is where I want to be. Thanks!


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I wouldn't say other research is a red flag. Ortho, especially ortho spine or peripheral nerve, research can overlap with neurosurgery. It would, however, be better to have neurosurgery research. Also, lacking neurosurgery research entirely, while having a plethora of ortho research, might raise suspicions that you're not committed to neurosurgery.

 

[Psai]

I have class, sass, and a whole lot of ass.


Large dogs

Gonna need pics

 

[The Buff OP]

I have class, sass, and a whole lot of ass.


Large dogs

for some reason I read your name as "tamales." lol

 

[tantacles]

Gonna need pics

Just look on any gay porn site and imagine someone just a little bit uglier and chubbier. That'll do!


Large dogs

 

[neusu]

How much do you squat?

On a serious note, are squats bad for you? Over the years I have noticed this lump that formed by my T1/T2.

Oh gosh, I don't really lift any more. I'll have streaks where I think I'll get back in to it. These streaks last a month or two at best, more often 2-3 weeks so I just get past the new lifter DOMS. If I went to the gym today I could probably do like 275?

Squats are actually good for you. Any compound muscle group exercise builds overall strength and stability. Just make sure you use proper form and don't over do it. I'd have to see this lump you're describing to speculate as to what it is. I tend to try to roll the bar slightly down on to my rhomboids so it's not pushing directly on my spine. Other people I've seen will wrap a towel around the bar, have a foam pad, or the manta ray bar holder.

 

[neusu]

That would be cool.

Do you feel like 7 years is just right or 5 years is enough?

This is a tough question. The board of neurosurgery wants to establish a level of care by which all neurosurgeons who complete training are capable of performing. Every institution is different in their resources available and specifics of training. Likewise, the current expectation is that a general neurosurgeon can and will do everything. Many programs could likely get away with the current expectation of training in 5 years if they cut a lot of things like elective rotations and research. Neurosurgery has long been known for establishing research as a prerogative, so much so that it's included in the 7-year model. My understanding of the proposal to switch to a 5-year + fellowship model is that in the 5 years, it would train basic general neurosurgeons. That is, people who could handle emergencies, the bread and butter things, but who would refer anything complicated to someone who was fellowship trained in that field. Alternatively, from what I am interpreting the recent moves by the neurosurgery leadership, is to keep training at 7-years, but allow for a clinical focus (or enfolded fellowship) in lieu of research. This seems to be a better approach in that it trains neurosurgeons who are qualified for a greater breadth and complexity of general neurosurgery, while also allowing for specialty training during residency. Only time will tell how things play out.

 

[The Buff OP]

Oh gosh, I don't really lift any more. I'll have streaks where I think I'll get back in to it. These streaks last a month or two at best, more often 2-3 weeks so I just get past the new lifter DOMS. If I went to the gym today I could probably do like 275?

Squats are actually good for you. Any compound muscle group exercise builds overall strength and stability. Just make sure you use proper form and don't over do it. I'd have to see this lump you're describing to speculate as to what it is. I tend to try to roll the bar slightly down on to my rhomboids so it's not pushing directly on my spine. Other people I've seen will wrap a towel around the bar, have a foam pad, or the manta ray bar holder.

275, not bad.

I had it check out a while back (I thought it was a lipoma). I had a derm and general surgeon look at it, supposedly there is nothing there to take out.

Nah, it looks more like this (not my pics).
http://s1100.photobucket.com/user/pclifton/media/PHOTOBOX467.jpg.html
http://forum.bodybuilding.com/attachment.php?attachmentid=276357&d=1139464640

 

[The Buff OP]

My understanding of the proposal to switch to a 5-year + fellowship model is that in the 5 years, it would train basic general neurosurgeons. .

I ain't trying to be no basic, yo! lol

I guess 7 years shouldn't really bring down someone if they really love what they do. Other people do go into longer paths too (GS 5 years + fellowship 1-3 years).

 

[Guero]

I ain't trying to be no basic, yo! lol

I guess 7 years shouldn't really bring down someone if they really love what they do. Other people do go into longer paths too (GS 5 years + fellowship 1-3 years).

Electrophysiology has become insanely long, too: IM x3yrs, Cards Fellowship x3 years, Ephys Fellowship x2yrs.


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[The Buff OP]

Electrophysiology has become insanely long, too: IM x3yrs, Cards Fellowship x3 years, Ephys Fellowship x2yrs.


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"I wanna put pacemakers in people" Say no more, fam. --->IM x3yrs, Cards Fellowship x3 years, Ephys Fellowship x2yrs.

 

[neusu]

Just saying hi @neusu


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Hey there! How are things?!?

 

[neusu]

275, not bad.

I had it check out a while back (I thought it was a lipoma). I had a derm and general surgeon look at it, supposedly there is nothing there to take out.

Nah, it looks more like this (not my pics).
http://s1100.photobucket.com/user/pclifton/media/PHOTOBOX467.jpg.html
http://forum.bodybuilding.com/attachment.php?attachmentid=276357&d=1139464640

Interesting. If the derm and GS guys haven't an idea, I stand no shot.

 

[neusu]

I ain't trying to be no basic, yo! lol

I guess 7 years shouldn't really bring down someone if they really love what they do. Other people do go into longer paths too (GS 5 years + fellowship 1-3 years).

Yeah, it's a trade off. Also, with the current system in place, and functioning as expected, there is not a force driving for a change.

 

[fancymylotus]

Hey there! How are things?!?

Good! Can't complain. Thank god. How are you????


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[IlyaR]

I wouldn't say other research is a red flag. Ortho, especially ortho spine or peripheral nerve, research can overlap with neurosurgery. It would, however, be better to have neurosurgery research. Also, lacking neurosurgery research entirely, while having a plethora of ortho research, might raise suspicions that you're not committed to neurosurgery.

Thank you! As a follow up, would you mind telling me which year of med school you started neuro research? Appreciate your response


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[The Buff OP]

Interesting. If the derm and GS guys haven't an idea, I stand no shot.

Yeah, I guess overtime to some lifters this thing pops up since it's common. Or maybe we grow an extra muscle? lol

 

[neusu]

Good! Can't complain. Thank god. How are you????


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I'm well, thanks. Keeping on keeping on.

 

[neusu]

Thank you! As a follow up, would you mind telling me which year of med school you started neuro research? Appreciate your response


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I started during my first year of medical school. Most schools that have a residency program have ongoing projects that you can be a part of.

 

[neusu]

Yeah, I guess overtime to some lifters this thing pops up since it's common. Or maybe we grow an extra muscle? lol

I am no expert, but I wouldn't be surprised if it was some sort of repetitive stress injury effect e.g. soft tissue thickening to reduce direct force on bone/fascia. We get calluses on our hands and skin, perhaps there is a deeper tissue response that is similar?

 

[The Buff OP]

I am no expert, but I wouldn't be surprised if it was some sort of repetitive stress injury effect e.g. soft tissue thickening to reduce direct force on bone/fascia. We get calluses on our hands and skin, perhaps there is a deeper tissue response that is similar?

That's probably it.

Do you like working trauma cases?

 

[idkididk]

You're probably sick of hearing about this book, but I just wanted to share this quote from When Breath Becomes Air.

"While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability— or your mother’s— to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?"

Damn. How often do you think about stuff like this?

 

[neusu]

That's probably it.

Do you like working trauma cases?

I do. They can be very exciting. That being said, they do become tiring, especially when frequent.

 

[WhittyPsyche]

Not at all, it's always nice talking to the folks who will be the future of medicine. I just hope we can attract some to carry on neurosurgery!

I've been lurking in this thread for years, reading intently and getting all my questions asked by other people lol. I feel like I shy away from expressing interest in neurosurgery because most people react to it like "yeah, right" "you're crazy".

But I just wanted to say that you have absolutely been a great motivator and so very informative. You have definitely cemented my feelings towards neurosurgery and I don't want to sound too gun-ho but it's I really feel like it resonates with me more than anything.

So questions.

What advice do you have to getting into research in medical school. Is expressing interest from day 1 seen as naïveté? How do you go about seeking opportunities the right way?
My current research experience is in neuroscience and psych, and I have a position lined up in clinical neuro for my gap year.

I'm considering applying to a few MSTP programs. On average MD/PhDs seem to have 80-20 research/clinical which is definitely not what I want. But one of my mentors, a MD/PhD neurologist said the only people he knows that pull off a 50-50 split are neurosurgeons. Do you have any colleagues like this? Is that an attainable set up? I would only apply if I could be sure that was a possibility (probability> .8/.9), I love both sides and would not want just 20% clinical.


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[neusu]

You're probably sick of hearing about this book, but I just wanted to share this quote from When Breath Becomes Air.

"While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of our selves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability— or your mother’s— to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?"

Damn. How often do you think about stuff like this?

I haven't read that book. The quotes seem a little dramatic, however we do frequently deal in these terms. As a surgeon, I try as best I can to not interject my beliefs when having these discussions. There are at times, however, where the objective of our intervention, risk, and benefit therein, are tragically opposed to the patient or family's hope.

 

[The Knife & Gun Club]

Hi thanks for doing this!

Out of curiosity, did you know anyone who wanted to go into neurosurgery that was unsuccessful/didn't match?

If so, what seems to be most common reason for unsuccessful applicants (bad step, no pubs, bad pre-clinical/clinical grades, etc.) ?

 

[neusu]

I've been lurking in this thread for years, reading intently and getting all my questions asked by other people lol. I feel like I shy away from expressing interest in neurosurgery because most people react to it like "yeah, right" "you're crazy".

But I just wanted to say that you have absolutely been a great motivator and so very informative. You have definitely cemented my feelings towards neurosurgery and I don't want to sound too gun-ho but it's I really feel like it resonates with me more than anything.

So questions.

What advice do you have to getting into research in medical school. Is expressing interest from day 1 seen as naïveté? How do you go about seeking opportunities the right way?
My current research experience is in neuroscience and psych, and I have a position lined up in clinical neuro for my gap year.

I'm considering applying to a few MSTP programs. On average MD/PhDs seem to have 80-20 research/clinical which is definitely not what I want. But one of my mentors, a MD/PhD neurologist said the only people he knows that pull off a 50-50 split are neurosurgeons. Do you have any colleagues like this? Is that an attainable set up? I would only apply if I could be sure that was a possibility (probability> .8/.9), I love both sides and would not want just 20% clinical.


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Life is a balance. Certainly, as an M1, it can be perceived as naive to pursue research. For every student who follows through on a project, there are five who seem bright-eyed, bushy-tailed, and motivated but fail to follow through. Communicating your interest and ability to deliver is helpful. That being said, before you do anything, get a lay of the land for your classes. It would be foolish to take on a project and then become overwhelmed, perform poorly on your project and in class.

Opportunities are always available. Contacting residents, fellows, or attendings and asking for their guidance. Your classmates are also an asset. See if there are M2-4s who have done research and work with them on getting in to the fold. Sometimes the Dean's office will have a list of ongoing projects as well.

It sounds like you are off to a good start. See how the experience you have can be applied to projects in the neurosurgery department.

The commitment to research and clinical activities is dependent on the individual. When negotiating for salary and research funding, these topics come in to play. For the most part, it depends on how much you want to do each, and how little you are willing to get paid to fulfill this desire.