Ask a neurosurgery resident anything

[neusu]

Do you mind a PM?

Sure, go ahead

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[bae2017]

I would have to read the discussion you are referencing. In my experience, no one is bullied out of a residency. There certainly can be personality differences and inter-resident conflict, but these things tend to sort themselves out. When a resident leaves, or is asked to leave a program, there is an underlying issue that is brought to the resident's attention, he fails to address it appropriately, is remediated and given opportunity to show improvement, and ultimately fails. Likewise, the experience as a medical student is far different than a resident. Many residents have a change of heart, and realize they entered the field for the wrong reasons, and ultimately pursue another specialty. Neurosurgery is an incredibly tough field, both with the volume and complexity of the pathologies with which we deal. Add to that other difficulties such as academic, interpersonal, personal, health or financial and it becomes too much for many. That is not say they are not great, and exceptionally capable people, simply the timing was not right.

Probably not the thread @Saifa was referencing but I did see this and thought it was relevant
"Gentlemen's" Programs

 

[neusu]

Probably not the thread @Saifa was referencing but I did see this and thought it was relevant
"Gentlemen's" Programs

Quite interesting. I can't say I'm surprised. There are three sides to every story: the protagonist's, the antagonist's, and the reality. I presume we are only seeing one side here.

 

[Dantes]

Probably not the thread @Saifa was referencing but I did see this and thought it was relevant
"Gentlemen's" Programs

Wow...hard to believe that thread is supposed to be full of actual neurosurgeons. Looks more like a bunch of 12 year olds fighting on 4chan

 

[neusu]

Wow...hard to believe that thread is supposed to be full of actual neurosurgeons. Looks more like a bunch of 12 year olds fighting on 4chan

Many of them are likely current medical students. When I was applying, there was a similar site called Uncle Harvey. It had a lot of useful information for applicants, but also a lot of flame wars.

 

[892002]

Hi Neusu! Thank you so much for doing this!!

I've been interested in neurosurgery for a while. I'm an incoming M1 and was wondering if you had any suggestions about what to do the summer before medical school. Because of how important research is, do you think it's a good idea to relocate early and get a head start on research? Or do you think this time is better spent relaxing?

Thank You!

 

[neusu]

Hi Neusu! Thank you so much for doing this!!

I've been interested in neurosurgery for a while. I'm an incoming M1 and was wondering if you had any suggestions about what to do the summer before medical school. Because of how important research is, do you think it's a good idea to relocate early and get a head start on research? Or do you think this time is better spent relaxing?

Thank You!

It wouldn't hurt. Two things, though. First, coming on too strong and not delivering is a bad thing. Make sure you know yourself and your dedication. As an m1 you know nothing, and even to get started will be a lot of background reading and teaching yourself. Second, med school is a lot harder than undergrad and the stakes are higher. Make it clear you want to start a project but will pull back once school starts until you have a handle on how much work school will be, and how much you can spare for research. Finally if you plan to bail because it's too much, please tell your advisors. Ghosting the project not only looks bad for you, but sandbags all future students who are interested because of the bad experience you provided.

 

[I'mJustCurious]

1. Do you have days where you don't feel like doing anything? If so, how do you get yourself up?
2. What type of music do you like to play when operating?

 

[coramDeo]

Hey thanks for doing this, it's been insightful beyond words and I hope to go through the entire thread one day. Meanwhile, a question for you, and I apologize if it is a duplicate.

How does one become a "good, renowned, excellent, etc.." neurosurgeon? What would be the criteria that you would use to rate - for the lack of a better word - neurosurgeons? And to extend, do you think there are people that are simply more talented - be it their hands, minds, etc - that are meant/born to be better physicians? As how certain athletes have a superior level of athleticism(talent) even amongst his/her peers?

 

[neusu]

1. Do you have days where you don't feel like doing anything? If so, how do you get yourself up?
2. What type of music do you like to play when operating?

1. All of the time. If I am not working that day, I tend to take it easy and relax. I read and catch up on things that I might have been putting off. If I have to work, generally, I feel compelled to go through the motions. We all have off days, but for me, anyhow, having a routine helps. That way, even if I am not motivated, I can go through the motions and get done what needs to get done.

2. It varies by the day and the case. When I was a resident, I would typically try to figure out what music the attending I would be working with liked and have a custom play-list for their room. Now, I pick what I want. I seem to have a knack for having play-lists that everyone enjoys, so much of the time I will just see who my circulator or scrub or anesthesia team is and pick something I know they like that fits my mood and cases.

 

[neusu]

Hey thanks for doing this, it's been insightful beyond words and I hope to go through the entire thread one day. Meanwhile, a question for you, and I apologize if it is a duplicate.

How does one become a "good, renowned, excellent, etc.." neurosurgeon? What would be the criteria that you would use to rate - for the lack of a better word - neurosurgeons? And to extend, do you think there are people that are simply more talented - be it their hands, minds, etc - that are meant/born to be better physicians? As how certain athletes have a superior level of athleticism(talent) even amongst his/her peers?

This depends on what you define as "good," "renowned," and "excellent." For the most part, the biggest names in neurosurgery are such because they have a combination of factors you mention. I tend to categorize these in to three categories: surgical ability, personality, and research.

For surgical ability, being a good surgeon takes a lot of practice and studying. You are correct, there are some who simply have better hands than others. Even so, dogged determination and hard work will make anyone a proficient surgeon. To be a technical master, however, takes both dogged determination (striving for excellence) and a bit of natural talent.

Personality plays a role, both with interactions with patients and their families, as well as other surgeons, and on the national stage. Making the right connections and playing the political game will definitely help escalate a career and put you in the national spotlight.

Research, though, is something on which a renowned surgeon gains a foothold. Being a part of major studies, and having an excellent CV, contributes immensely to a career. This can also be a self-propagating endeavor as being a player on the national scene will result in being asked to be a part of other big things as it lends credibility.

The short answer is that it takes a bit of all three to be great. Even so, there are great technical surgeons who are unknown, and big name researchers who are hacks in the OR.

 

[LebronManning]

What would you recommend an incoming MS1 to read/study/look up to start to understand the state of neurosurgery today and also to gauge one's interest in it?

 

[neusu]

What would you recommend an incoming MS1 to read/study/look up to start to understand the state of neurosurgery today and also to gauge one's interest in it?

For the former there really isn't much that can be read or studied, it's a perception thing that is gained through first hand experience. Likewise, the best way to gauge interest is to spend time on service See what we do, how we do it, and why.

 

[christownes]

Strength training, when done with proper form, is good for strengthening muscle and bones, including the spine. The issue with things like squats and deadlifts, is people use bad form, or try to do too much weight, and end up with injuries. Therapy can help with recovery, but two things to consider: 1) as we grow older recovery takes longer and longer and is less likely to return to prior baseline 2) injured tissue is never as "good" as the pre-injured tissue.

I do have a battle battle station, both at my home office and my work office. At work I have a 8-core processor with 32 gb RAM and a Titan XP running two displays. At home I have another 8-core i7 with 64 gb RAM and 2x 980 Ti running two 4k displays and two 1080p displays. I typically run Windows 10, but have them set up to dual boot Linux and MacOS if I need those for any reason. I never really find the organizational software to actually help much, so I tend to have a routine for where I keep things and how I track changes. Moreover, a lot of the software that is purportedly supposed to organize/manage is buggy and bloated in my assessment (e.g. Endnote, Word, etc.).

As a former software engineer, I'm very curious why you might ever have to boot into a Linux machine. That's an impressive setup for someone not dedicated to gaming!

 

[neusu]

As a former software engineer, I'm very curious why you might ever have to boot into a Linux machine. That's an impressive setup for someone not dedicated to gaming!

Generally I use windows for day to day stuff and making PowerPoints. I use Mac OS for Video editing and for applications when I work with people devoted to that ecosystem. I find Linux to be the most versatile for everything including video editing, but also data analysis and management.

 

[LebronManning]

Are you allowed to wear a go pro during surgery if you have patient consent?

 

[neusu]

Are you allowed to wear a go pro during surgery if you have patient consent?

Simple answer, yes. Longer answer is that all procedures have within the consent that we may record portions (e.g. Microscope or head mounted camera), take photos, or have trainees involved in the procedure.

The real issue is the camera. It is difficult to have the lighting and field of view precisely what the surgeon desires using a head mounted camera. Even so, we are working on the technologies and there are new innovations all of the time.

 

[deepred]

Hi @neusu thanks for this thread! It's been very helpful. Another question about away rotations:

In addition to a completed home nsg sub-I, I have two aways lined up and ready to go for early summer, with a third at a decently competitive program awaiting acceptance. Is it worth it to do that third one to widen the geographical net, prove myself at another program, and/or to show my dedication to the field, against not needing a LOR from there (because it would be over the max of 4) and the risk of not performing as well due to away burnout?

 

[LebronManning]

So the image in my mind of a Neurosurgery resident and subsequent Neurosurgeon is that of utmost organization, work ethic, etc. all the time. I wonder..do you still find time to occasionally kick back and watch some Netflix?

Were you always hyper organized and had your **** together or did this develop with your interest in NSGY in medical school?

 

[neusu]

Hi @neusu thanks for this thread! It's been very helpful. Another question about away rotations:

In addition to a completed home nsg sub-I, I have two aways lined up and ready to go for early summer, with a third at a decently competitive program awaiting acceptance. My ERAS application is pretty average for nsg. Is it worth it to do that third one to widen the geographical net, prove myself at another program, and/or to show my dedication to the field, against not needing a LOR from there (because it would be over the max of 4) and the risk of not performing as well due to away burnout?

Tough to say. If there is a program that you have interest, go for the away.

For what it is worth, if you are burnt out after two months of subinternship, that is not a good sign. Residency is that same intensity, or more, for 7 years straight.

 

[LebronManning]

Do patients every code or die during brain surgery?

 

[deepred]

Tough to say. If there is a program that you have interest, go for the away.

For what it is worth, if you are burnt out after two months of subinternship, that is not a good sign. Residency is that same intensity, or more, for 7 years straight.

That makes sense. Thanks for the advice!

 

[neusu]

So the image in my mind of a Neurosurgery resident and subsequent Neurosurgeon is that of utmost organization, work ethic, etc. all the time. I wonder..do you still find time to occasionally kick back and watch some Netflix?

Were you always hyper organized and had your **** together or did this develop with your interest in NSGY in medical school?

I never considered myself particularly well organized. I tend to keep track of everything in my head, which as the amount of things of which you are keeping track, builds, becomes increasingly difficult. Everyone figures out a system that works for themselves, and part of junior residency is determining what needs to be kept track of and what can be let go. Pattern recognition is also very important.

 

[LebronManning]

Do patients code or die during brain surgery? I only ask this because I would think even in cranial emergencies the patient is probably able to stay hemodynamically stable given that its all being monitored and manipulated. I'm still early in my education so forgive me if this is a dumb question.

 

[zarolamiko]

Hey Neusu. Incoming medical student, interested in neurosurgery. I'm interested in academic neurosurgery as of now (obviously I could do a 180 in 3 months), but I've had some mentors talk to me in regards to looking at summer scholarships/awards. These allow me to go to any other institutions. I'm a Southern California native, and as I have gone to college and now medical school far away, I would really do whatever it takes to be able to match at a solid program down in southern california. Is it reasonable to do research at an institution where you would want to match, or should you stay at your home program?

 

[neusu]

Do patients every code or die during brain surgery?

It is very uncommon during elective cases. I have had patients Code during trauma cases, but the underlying injury to the major organ systems are what caused the code, not so much the brain injury.

 

[neusu]

Hey Neusu. Incoming medical student, interested in neurosurgery. I'm interested in academic neurosurgery as of now (obviously I could do a 180 in 3 months), but I've had some mentors talk to me in regards to looking at summer scholarships/awards. These allow me to go to any other institutions. I'm a Southern California native, and as I have gone to college and now medical school far away, I would really do whatever it takes to be able to match at a solid program down in southern california. Is it reasonable to do research at an institution where you would want to match, or should you stay at your home program?

These opportunities are great, but very competitive. If you can find a mentor to supervise a project on which you'd like to work in a region you'd like to be, that's great. It may be easier, logistically, to coordinate this at your medical school.

 

[BuckStrickland]

I was reading a memoir by Henry Marsh, retired neurosurgeon from the UK, and he mentioned that some neurosurgeons are only allowed to operate once per week because they have such few cases, combined with the trend towards non-invasive methods. Most neurosurgeons apparently do mostly spine.

What would you say about the case diversity/load as a neurosurgeon in America? Do you think it will be similar 10+ years down the line?

 

[neusu]

I was reading a memoir by Henry Marsh, retired neurosurgeon from the UK, and he mentioned that some neurosurgeons are only allowed to operate once per week because they have such few cases, combined with the trend towards non-invasive methods. Most neurosurgeons apparently do mostly spine.

What would you say about the case diversity/load as a neurosurgeon in America? Do you think it will be similar 10+ years down the line?

I'm not sure how things are in the UK, but in the US, most neurosurgeons are very busy. Even though the trend is for less invasive procedures and treatments, the indications and ability to diagnose things are expanding. We find pathology earlier in the course and are able to augment the disease course, which for some treatments results in a longer involvement on our part.

In private practice, many neurosurgeons do mostly spine. There is no shortage of back pain, and the patients tend to be less sick and recover faster than the average onc or vascular case.

Certainly, the trend towards less invasive treatments will continue. That being said, human nature being the way it is, people will continue to harm themselves acutely or chronically in new and innovative ways, resulting in the need for our particular set of skills.

 

[LebronManning]

Are endovascular interventions within the scope of practice for a Neurosurgeon who did not receive advanced fellowship training for this? Surely in an academic setting only the fellowship trained guys will be doing them but I'm curious about private hospitals. Will they let neurosurgeons without fellowship training do coilings? How about stroke intervention?

 

[neusu]

Are endovascular interventions within the scope of practice for a Neurosurgeon who did not receive advanced fellowship training for this? Surely in an academic setting only the fellowship trained guys will be doing them but I'm curious about private hospitals. Will they let neurosurgeons without fellowship training do coilings? How about stroke intervention?

I can't say for certain, but it likely depends on the hospital.

There are a number of factors to consider. First, the extent of training performed during residency. The neurosurgery CAST requires 200 diagnostic angiograms as the operative surgeon, 40 aneurysms, and 30 stroke interventions. Most programs with the volume required to achieve this have fellows, and thus, the residents may not receive the experience necessary. Further, it would likely require an extended dedicated endovascular rotation during residency. Next, a surgeon can apply for privileges/credentials to perform any case they have the case logs to support their proficiency. Arguably, a resident who has done 200 diagnostic angiograms, 40 aneurysms, and 30 stroke interventions, as the lead surgeon, could apply for these privileges. The next issue comes from turf overlap. There is no way a fellowship trained interventional radiologist or interventional neurologist would be ok having a neurosurgeon show up without fellowship training and start doing cases. Finally, to what end? If you are not fellowship trained in vascular, the ability to utilize this skill set, or perform cases derived from these diagnostic procedures is limited. That is, if I do an angiogram and find carotid stenosis or an aneurysm, I book it for an endarterectomy or stent or a clip or coil. Someone who has not completed a vascular neurosurgery fellowship may well want to clip aneurysms or do endarterectomies. Unfortunately, practice patterns and standard of care being what they are, this opens them to significant liability. That is, if they clip an aneurysm and the patient strokes and dies, the natural question would be "well why did they not refer it to the vascular neurosurgeon?" Whereas if the vascular neurosurgeon has the same case with the same outcome, that question is not asked (unless they have a pattern of bad outcomes).

 

[LebronManning]

So with a lot of neurovascular stuff going to be in the hands of Neuro IR and fellowship trained neurosurgeons..how do you think this will affect the job market for general neurosurgeons over the next 25 years?

As it is now, I hear neurosurgery is one of the most in demand specialities out there. Will there be enough case load of tumors, trauma, and spine to go around? I feel like the value of a neurosurgeon to a hospital goes even beyond case volume. I.e. even if trauma doesn’t come in, the hospital needs to have neurosurgery staffed at all times.

 

[neusu]

So with a lot of neurovascular stuff going to be in the hands of Neuro IR and fellowship trained neurosurgeons..how do you think this will affect the job market for general neurosurgeons over the next 25 years?

As it is now, I hear neurosurgery is one of the most in demand specialities out there. Will there be enough case load of tumors, trauma, and spine to go around? I feel like the value of a neurosurgeon to a hospital goes even beyond case volume. I.e. even if trauma doesn’t come in, the hospital needs to have neurosurgery staffed at all times.

Vascular neurosurgery has typically always been the purview of a fellowship trained vascular neurosurgeon. Most community guys ship anything vascular off to a tertiary center with someone who specializes in it. The liability and risk:reward factor is simply too high.

With respect to need for neurosurgeons who do not do vascular, it will always be there. While the techniques and indications change, the volume only increases. Two examples: brain metastasis and back pain. For the former, we previously would do a craniotomy for tumor, gain a diagnosis or decrease tumor burden and hand off the patient to the oncologist/rad onc. The patient would languish and die from their cancer sometime in the next 4 months to 1 year. Now, they have a biopsy +/- resection and the options for stereotactic radiosurgery. The oncologists are far better at disease control/cure and the patient continues to live 5+ years. They then return years later with another metastasis. Rinse/repeat. Back pain is not going anywhere. The surgeries tend to be less invasive, but the volume is only increasing for both.

Also, for vascular in particular, and I am biased here, neurosurgeons are in particular demand. We really are the only ones have a multi-modal approach to management. That is we do open surgeries, endovascular approaches, or a combination. Neither neurology nor radiology can say that. Likewise, we have a robust experience managing these patients in the ICU. Again, the volume is only increasing for these pathologies as the imaging technologies and screenings are improving. At our center, any patient who arrives with TIA or stroke has a CTA. While the low NIH SS patient may not need an acute intervention, the stroke study may demonstrate other pathology which went previously undiagnosed. If it warrants treatment, we are involved.

 

[LebronManning]

That makes sense about the cerebrovascular stuff.

What are some of the most rewarding moments you've had in your career thus far? Maybe you could give one example of a great outcome and the patient and their family's reaction.

 

[deleted862527]

Hi everybody. I noticed interest in the discussion with resident/intern from general and vascular surgery and wanted to offer some insight on another surgical sub-specialty, neurosurgery. Feel free to ask away regarding whatever questions you may have from general what do we do questions to how to lay plans to pursue this field. I'll try to check back and get to each of your questions, feel free to PM me for anything you don't want to ask in a public forum. Also, there is an attending in the neurosurgery forum writing from his perspective: Answering Questions - Recent Neurosurgery Graduate

To the resident:

How do you cope with stressful, sleep-deprived days? How do you cope with doubt? Obviously neurosurgery is one of the toughest and most competitive residencies to be in, and this is anxiety-provoking to those seeking spots. What is your advice for them?

 

[neusu]

That makes sense about the cerebrovascular stuff.

What are some of the most rewarding moments you've had in your career thus far? Maybe you could give one example of a great outcome and the patient and their family's reaction.

This is a tough question. There are so many rewarding things along the way.. As we learn the art and science of the field, each little step can be monumental e.g. the first EVD I placed or first craniotomy I performed. There are patients I remember for things that I found to be remarkable. Over the years the combination of sleep deprivation, fatigue, and never-ending influx of new and interesting cases they tend to fade together. Whats more, the cases that go wrong tend to haunt us and for whatever reason be much more memorable. Perhaps it is so we do not repeat our past, or the feeling of being unable to help is more impacting, but these tend to be the cases I remember. When I talk to my colleagues, it seems, everyone has a litany of such cases that stand out in their mind. We do talk about the wins, and often hold them up on platforms in front of audiences to espouse the wonderful things we can do. Though, for me, the cases that do not go well tend to be more memorable.

 

[neusu]

To the resident:

How do you cope with stressful, sleep-deprived days? How do you cope with doubt? Obviously neurosurgery is one of the toughest and most competitive residencies to be in, and this is anxiety-provoking to those seeking spots. What is your advice for them?

Coping with stress and sleep deprivation varies by individual. I generally just power through it. Years of acclimation have recalibrated my sleep meter, so I get by on less sleep than the recommended 8-hours a night. Stress really can be contextual and much of it is how we react to challenges. What one person considers stressful, another may not. Being mindful and re-framing stress works for me. Likewise, trying to ensure adequate sleep of sufficient quality and other outlets such as exercise, nutrition, and so forth. It sounds contradictory to say I get less sleep than most people and then advocate for adequate/more sleep. What I mean is, don't sleep when you don't need/want to, and when you do sleep, make sure it is of good quality.

Doubt can be an interesting phenomenon as well. I tend to both continuously doubt myself all while having no fear. When I was a junior resident, not knowing any better, I assumed the more senior resident or attending or even the training paradigm itself would have safe guards and continuous checks on what I was doing to keep me out of trouble. While in theory this is true, in practice it is a little less feasible. So, with that in my mind, I would plod forward, forever doubting my ability, and push myself past my comfort level, assuming someone would stop me or step in when things looked awry. I think back in horror of how much trouble I could have gotten myself in to, but, knowing myself, if things had gone less then optimal I would have stepped back myself before they went too far off the deep end. In any case, every one will have doubts. Being competitive people by nature helps us push ourselves past our limits.

Neurosurgery is tough to be in, and can be very anxiety inducing. Taking things one step at a time, day by day, working to improve, and seeking opportunities to demonstrate this help to allay these concerns.

 

[LebronManning]

So obviously NSGY residency allows very little free time, but are you still able to go on dates or go out for a drink with friends once or twice a week?

How does your hours compare with other specialties notorious for high hours like surgery residents or cards fellows?

 

[Ijustwantdownloadpicture]

Hello, neusu. Thanks for this thread
My question is - Did you see international students at neurosurgery residency?

 

[neusu]

So obviously NSGY residency allows very little free time, but are you still able to go on dates or go out for a drink with friends once or twice a week?

It depends on the resident and the week. For the most part, no. In my more junior years, I was more interested in getting out and seeing friends etc. I would try to make time for this, and generally once a week or every other week would be able to. As I became older, this was less of a priority in my life and I realized sleep and recovery (mental and physical) from long days was more important.

How does your hours compare with other specialties notorious for high hours like surgery residents or cards fellows?

I have never been a surgery resident or cards fellow, but I can say when I was on endovascular we were there before the cards fellows and there after them every single day.

Most programs make an effort to pretend to abide by the duty hours. That being said, the amount of outside the hospital work seems to have increased dramatically (at least in my assessment), and somehow, board scores are actually down.

 

[neusu]

Hello, neusu. Thanks for this thread
My question is - Did you see international students at neurosurgery residency?

We always have international students as observers or rotating through. I have yet to see one match in the US, however.

 

[LebronManning]

It depends on the resident and the week. For the most part, no. In my more junior years, I was more interested in getting out and seeing friends etc. I would try to make time for this, and generally once a week or every other week would be able to. As I became older, this was less of a priority in my life and I realized sleep and recovery (mental and physical) from long days was more important.



I have never been a surgery resident or cards fellow, but I can say when I was on endovascular we were there before the cards fellows and there after them every single day.

Most programs make an effort to pretend to abide by the duty hours. That being said, the amount of outside the hospital work seems to have increased dramatically (at least in my assessment), and somehow, board scores are actually down.

Makes sense. My question was to assess the viability of starting a life during residency as these tend to be very precious and the last "young" years of one's life. For example, this would be the time many would meet their wives (would need to be able to date) and have kids. Do you think these things are still possible?

 

[floverwatch]

Would say you have significantly steady hands? Do you ever have trouble with your hands shaking or getting tired during surgeries, and how do you compensate for this?

 

[neusu]

Makes sense. My question was to assess the viability of starting a life during residency as these tend to be very precious and the last "young" years of one's life. For example, this would be the time many would meet their wives (would need to be able to date) and have kids. Do you think these things are still possible?

Life happens regardless of your intent one way or another. For your own sake, your patients' sake, and co-resident's sake, I would prioritize residency during residency. Many residents date and get married during residency. Many don't.

 

[neusu]

Would say you have significantly steady hands? Do you ever have trouble with your hands shaking or getting tired during surgeries, and how do you compensate for this?

Everyone has a tremor. This is especially noticeable under high magnification. We all learn compensation techniques and ways of overcoming these phenomenon.

 

[I'mJustCurious]

How much free time do you have every day? Do you watch tv, if so what do you like to watch?

Any technology (headphones, tablets, etc) you would recommend to help learn better?

 

[neusu]

How much free time do you have every day? Do you watch tv, if so what do you like to watch?

Any technology (headphones, tablets, etc) you would recommend to help learn better?

Free time is relative. Throughout the day, I may have a significant amount of free time between cases or between consults etc, however the standard "free time" wherein I have no obligation whatsoever is uncommon. Time management becomes a real valuable asset in the resident's tool box. I do not watch much TV.

Everyone learns differently, so what works for me may not work for anyone else. I find repetition to be useful, so flashcards were my thing. I would cut 3 x 5 note cards in to quarters and make stacks and stacks of flash cards to physically review. I would also use the Anki or a similar program on my phone. The issue I have with technology, is often, it in itself has a significantly high learning curve to learn to use it appropriately. Once you are up to speed on it, it can be useful, but often, in my assessment, fails to supplant whatever it is that it is supposed to be replacing. Moreover, most technologies we use attempt to parallel or improve on a prior existing format or technology e.g. why do my e-books still have page numbers and so forth.

 

[Zedor]

What’s your opinion on EC-IC bypass for medically refractory (ie. Recurrent stroke or TIA) chronic carotid occlusion?

 

[neusu]

What’s your opinion on EC-IC bypass for medically refractory (ie. Recurrent stroke or TIA) chronic carotid occlusion?

I'm a vascular guy, so personally I love them. I understand the literature and realize there are few indications. That being said, it is among my favorite procedures we do.

 

[I'mJustCurious]

1. What were you like in undergrad?
2. Were you always studying throughout the year in undergrad to prepare for the MCAT?