Ask a neurosurgery resident anything

[neusu]

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Do you think certain degrees like an MS in Clinical Research or an MS in Statistics can give a medical student an edge in obtaining a summer research position? Or would a summer research position be too brief for anyone to care?

Ideally, a summer research position could be transitioned in to a long term project for the remainder of medical school. A degree may be a bit of overkill unless you wanted to be a researcher. Statistics is very useful, but again a degree is likely excessive.

 

[smooththrow]

I know you've said the MD/PhD can definitely boost an application, but about how much influence do you think it would have on gaining a competitive neurosurgery residency when compared to a regular MD? If an MD busted a** for four years (near top of the class, excellent step 1, research & publications), how much of a disadvantage would he be at when compared to an MD/PhD with similar scores & rank, and more research? Would he need to stand out in some other significant way, is it something that could be overcome just by having good interviews, does it just depend on the specific residency spot, or is it something that just can't really be helped?

Thanks!

 

[neusu]

I know you've said the MD/PhD can definitely boost an application, but about how much influence do you think it would have on gaining a competitive neurosurgery residency when compared to a regular MD? If an MD busted a** for four years (near top of the class, excellent step 1, research & publications), how much of a disadvantage would he be at when compared to an MD/PhD with similar scores & rank, and more research? Would he need to stand out in some other significant way, is it something that could be overcome just by having good interviews, does it just depend on the specific residency spot, or is it something that just can't really be helped?

Thanks!

Interesting question. Obviously, it is program dependent how much a PhD is a bump. All other things being equal (same school/grades/scores/pubs/letters), I'd hope the MD alone has the advantage because a MD/PhD takes extra time. To some degree, in this case, the degree alone opens some doors or helps offset an otherwise borderline application. The scenario you described, wherein they're equal aside from more publications in the PhD applicant, would likely be in favor of the PhD applicant. This is both because of the extra degree and pubs. The balance may not be tilted far, not nonetheless is.

 

[altamont850]

OP:

I know its been awhile since you've been an undergrad, but how did you cope with the stress that most pre-meds continually must endure? In addition, how do you continue to cope with stress?

One of my professor said something to me the other day which caught my attention. In an nutshell, they said I had ability but stress would be the death of me if I didn't learn to relieve my stress. I'm always worried about the future and I'm always concerned with the competitive nature of applying to medical school despite my relative competitiveness. In other words, I'm always trying striving for perfect and I'm always "on."

 

[neusu]

OP:

I know its been awhile since you've been an undergrad, but how did you cope with the stress that most pre-meds continually must endure? In addition, how do you continue to cope with stress?

One of my professor said something to me the other day which caught my attention. In an nutshell, they said I had ability but stress would be the death of me if I didn't learn to relieve my stress. I'm always worried about the future and I'm always concerned with the competitive nature of applying to medical school despite my relative competitiveness. In other words, I'm always trying striving for perfect and I'm always "on."

First of all, don't sweat the small things and those which you have no ability to affect change. Find out what you can do to relax and get away. Try to get enough sleep and exercise regularly. That being said, I didn't really stress during undergrad. Mentally being able to seperate work/school from home helps so that you're not always "on.".

 

[2017Cycle]

Hi OP, first I would like to thank you for this thread it has been extremely helpful.

I am currently a pre-med in a gap year before I start med-school next fall. I have always had an affinity for neurosurgery so I will be starting a long term shadowing with a neurosurgeon at the start of the new year to "get a feel" before medical school. Do you have any advice on how to approach this shadowing to make sure I get the most out of the experience? What types of things can I do while shadowing to try and understand the field better?

Thanks for all of your help!

 

[Kvothe]

Any idea when it is legal for med students to start scrubbing in and assisting?

 

[neusu]

Any idea when it is legal for med students to start scrubbing in and assisting?

Generally, there aren't truly legal restrictions on medical student participation in surgery. Most hospitals have restrictions on who can be where (HIPAA release for being near patient information, OR safety/scrub instruction for scrubbing in the OR). Most surgeons are receptive to medical students wanting to shadow and/or scrub (M1/M2 year). It is expected that students will scrub during M3/M4 neurosurgery rotations.

Assisting in surgery involves a fair amount more than standing there scrubbed. Understanding the particular case from start to finish, the associated anatomy, and surgical preferences is important. As a resident, responsibility is typically increased in a graded fashion throughout training both on which cases the resident is involved in and the level of participation. As a medical student, assisting generally involves suctioning and irrigating, retracting, and possibly suturing/cutting knots. Being proficient at the current tasks that you are allowed to do and knowing the next step while showing awareness helps the surgeon understand that you are ready for another, more difficult, or important responsibility. It can be frustrating sometimes when one surgeon teaches and allows you to do many things while another is very restrictive. Keep in mind, everyone is there for the best interest of the patient and that responsibility is ultimately on the surgeon.

 

[neusu]

Hi OP, first I would like to thank you for this thread it has been extremely helpful.

I am currently a pre-med in a gap year before I start med-school next fall. I have always had an affinity for neurosurgery so I will be starting a long term shadowing with a neurosurgeon at the start of the new year to "get a feel" before medical school. Do you have any advice on how to approach this shadowing to make sure I get the most out of the experience? What types of things can I do while shadowing to try and understand the field better?

Thanks for all of your help!

When shadowing, try to get as broad a feel for the job as you can. When I shadowed as an MS1 it was rather humbling to realize how little I know about anything medical related. At that stage, learning the flow of patients through the hospital and types of diseases helps create an understanding for later. Likewise, seeing what the surgeon does at different stages gives you a global feel for the field. What I mean is, rather than show up for an afternoon of clinic or the OR, see if you can come early for rounds and then the OR/clinic so you see the diversity and acuity of settings in which patients are seen from ICU/the floor/clinic to the OR.

 

[tiedyeddog]

Any idea when it is legal for med students to start scrubbing in and assisting?

Neusu had a great response but I just want add I have scrubbed in as an M2 a couple times, you just need to find a receptive neurosurgeon.

 

[tiedyeddog]

I don't know if this is too specific for you but what is the most exciting/interesting case you've been on?

 

[neusu]

I don't know if this is too specific for you but what is the most exciting/interesting case you've been on?

Tough question! I'm very interested in vascular or skull base so my bias may show.

Most exciting - Trauma typically is exciting, more so that it has to come together ASAP than anything. Aneurysms and AVMs are exciting too because of the technical nature of the case and if they rupture it can be a nerve racking experience.

Most interesting - Anatomy wise, microvascular decompression for trigeminal neuralgia or hemifacial spasm and far lateral approach for foramenal or clival tumors are the most interesting.

 

[tiedyeddog]

Tough question! I'm very interested in vascular or skull base so my bias may show.

Most exciting - Trauma typically is exciting, more so that it has to come together ASAP than anything. Aneurysms and AVMs are exciting too because of the technical nature of the case and if they rupture it can be a nerve racking experience.

Most interesting - Anatomy wise, microvascular decompression for trigeminal neuralgia or hemifacial spasm and far lateral approach for foramenal or clival tumors are the most interesting.

Speaking of skull base, since you're interested in it, do you think neurosurgery will incorporate robotics like the Da Vinci a la what urology has done in skull base approaches? I know more skull-base guys are using it but it is more a novelty now unless I am totally off-base. Thoughts?

 

[Dash2021]

First, as many have already said but can't be stated enough, thanks for the thread.

Q: Have you heard of any neurosurgeons using loan forgiveness to dismiss their debts? As I understand it being in residency qualifies as working for a not for proffit company, meaning that if you make payments during a 7 year residency you only need to have 3 more years to work for a not for profit to qualify for PSLF.

I know that neurosurgeons are some of the higher paid physicians, but it seems that even a sizable pay cut for 3 or so years would make this an attractive idea. Any ideas?

 

[neusu]

Speaking of skull base, since you're interested in it, do you think neurosurgery will incorporate robotics like the Da Vinci a la what urology has done in skull base approaches? I know more skull-base guys are using it but it is more a novelty now unless I am totally off-base. Thoughts?

We've been looking in to the indications and possible surgeries. The ENT guys have been successful in incorporating it in to anterior neck surgeries and there are some reports of using it in trans-oral neurosurgery. I suspect it would be conducive to trans-nasal approaches too, but in the current form seems to be better suited for multiple port or wide angle aspect approaches which the nares would not accomodate (e.g. short wide tunnel vs long, narrow tunnel). Another drawback to the Da Vinci, from what I've heard, is it tends to prolong surgery. If someone can take out a gallbladder/pituitary tumor in 30 minutes with traditional endoscopy and adding a robot results in a 2-4 hour case, does it actually improve the current care? Nonetheless, an interesting concept to discuss.

 

[neusu]

Q: Have you heard of any neurosurgeons using loan forgiveness to dismiss their debts? As I understand it being in residency qualifies as working for a not for proffit company, meaning that if you make payments during a 7 year residency you only need to have 3 more years to work for a not for profit to qualify for PSLF.

I know that neurosurgeons are some of the higher paid physicians, but it seems that even a sizable pay cut for 3 or so years would make this an attractive idea. Any ideas?

A lot of the neurosurgery residents I talk to have their loans in the public service loan forgiveness program. They have several options for repayment, which are nice, including standard, income based, and graduated payment plans. Many residents defer or put their loans in forbearance during residency because the amount being paid per month is a sizable chunk of disposable income that could be utilized elsewhere.

That being said, there seem to be two general schools of thought: 1) Academic track: will be eligible for the PSLF because they will work for a nonprofit for the 10-year period 2) Private Practice track: may be eligible for PSLF, if they work for a hospital that is a nonprofit. If truly in private practice (e.g. solo practice or group practice in a for profit capacity) it really doesn't matter. To put it another way, often the difference in salary between academics and private practice is a factor of 2. To put some numbers to it, hypothetically you have $500,000 in loans and 2 job offers: academic job making 200,000 or a private practice job making $400,000, the difference of which is $200,000. In the 3 years you would require making payments to the loan to have it forgiven you would have made an additional $600,000, or $100,000 after paying off the loan, by not working for the nonprofit and taking the forgiveness.

 

[Dash2021]

Thanks for the clarification. This was more or less what I thought, but was good to hear it from someone more knowledgeable.

 

[tiedyeddog]

We've been looking in to the indications and possible surgeries. The ENT guys have been successful in incorporating it in to anterior neck surgeries and there are some reports of using it in trans-oral neurosurgery. I suspect it would be conducive to trans-nasal approaches too, but in the current form seems to be better suited for multiple port or wide angle aspect approaches which the nares would not accomodate (e.g. short wide tunnel vs long, narrow tunnel). Another drawback to the Da Vinci, from what I've heard, is it tends to prolong surgery. If someone can take out a gallbladder/pituitary tumor in 30 minutes with traditional endoscopy and adding a robot results in a 2-4 hour case, does it actually improve the current care? Nonetheless, an interesting concept to discuss.

Thanks for the discussion and thanks for contributing so much to this thread!

 

[neusu]

I'm pretty sure the regulations were based off of speculation rather than hard facts showing that resident performance dropped.

UCLA is/has conducted a study for surgery residents (not sure if it was specifically NS?) fine motor skills pre and post call. The data wasn't very convincing that post call reduced skills very much.

My favorite anecdote about old school NS residency training is how in some hospitals the first 6 months of yr 2 required the resident to see every single ER NS consult... Ever wonder why they are called residents?

There have been several studies regarding resident function in the end of call/post call period looking at logical reasoning, quantitative analysis, and tactile skills. From what I recall, for the most part, there does not seem to be a significant difference (perhaps I read what I wanted to hear from the articles and ignored what I didn't).

From discussions with residents at other institutions, a lot of departments do have a policy that every patient has to be seen e.g. everything is a formal consult and there is no curb-siding. That being said, many places put protocols in to place to prevent the neurosurgery service from being overly consulted (concussion, hemorrhagic stroke, spine injury, low back pain). While a lot of these consults are unnecessary, from my perspective, it is imperative every patient is physically seen by the resident and associated studies reviewed. The reason neurosurgery is called is because the other service is uncomfortable with a particular issue and needs guidance. Often, the service less familiar with a particular pathology or injury may overlook subtleties that differentiate something serious about to turn for the worse from a more benign case. Likewise, as much as it pains me to get those calls over the phone, seeing the patient makes you feel better and lets you sleep better at night knowing they are either fine or being appropriately treated.

 

[Sophocles]

Would you recommend someone that is trying to go to a selective program to take a year off in medical school to get some extra research?

 

[neusu]

Would you recommend someone that is trying to go to a selective program to take a year off in medical school to get some extra research?

This is hard to tell and is variable depending on your current program, scores/grades, research productivity thus far, and desired program. Some places nearly require a significant amount of research while others do not care as much. A year off can help boost you but is often unnecessary.

 

[Sophocles]

This is hard to tell and is variable depending on your current program, scores/grades, research productivity thus far, and desired program. Some places nearly require a significant amount of research while others do not care as much. A year off can help boost you but is often unnecessary.

So I'm assuming places like JHU and MGH pretty much require that extra year?

 

[mcloaf]

This is hard to tell and is variable depending on your current program, scores/grades, research productivity thus far, and desired program. Some places nearly require a significant amount of research while others do not care as much. A year off can help boost you but is often unnecessary.

Hmm. I know you've stated above that wet bench work is often considered more legit than paper-based stuff; does this mean that something like a Master's in Clinical Research would be more or less a waste of time in terms of any benefits for applying to neurosurgical residency programs?

 

[MedPR]

Is MGH really that awesome?

Sent from my SGH-T999 using SDN Mobile

 

[giants25]

Is MGH really that awesome?

Sent from my SGH-T999 using SDN Mobile

Yes. Yes it is.

 

[JGimpel]

.

 

[JGimpel]

👍👍👍 by the way.

 

[deleted393595]

This is going to be one of the stupidest questions on this thread, but as a resident, do you get any hospital perks? Like free food from the cafeteria?

 

[pgoyal]

yo neusu,

apologies if you've already answered these....slightly sleep deprived

1. are there travel opportunities? --> specifically i. i'm sure you can still do doctors without borders/etc right? ii. how do you travel for conferences? iii. can you do a research fellowship (in neuroscience/neurosurg) in europe/aus? iv. do you know anyone now practicing in europe/aus?

2. how late is too late to go into neuro? i mean what if you had no interest in neurosurg till your rotation 3rd year...given excellent scores+grades can you still manage a quick/start on a research project between 3rd and 4th year and be competitive for a decent program?

3. any info on what ped neurosurgery is like?

4. I think you mentioned that in private practice your vacation really depends on the group/structure right? what's the average, 4wks?

5. did any of your colleagues do research in cognitive computing/artificial intelligence

thanks man.

 

[ijn]

This has really been an outstanding thread and I applaud neusu for giving of his time when he has absolutely none. I'm not a resident in this specialty, but these are things I picked up along the way:

You must do an audition in neuro or general surgery at the location you want to train at. If it's a level 1 or level 2 trauma center, that's the most ideal.

You need to be able to do a full, attending-level neuro-exam on a patient every morning. A GCS score and deviation from it on your most acute cases should be known before your attending rounds. Know that an 11T means that they're intubated and anything above or below that needs to have a clinical context and a prognosis behind it. Account for propofol if they're on a continuous drip of it. You don't have to come up with this score all of the time, but if you can aid in getting it, you may be solicited for an interview if they know you're "auditioning."

You are not required to buy or memorize the "Greenberg book," but you will need to know where all of the most important bread and butter information can be found in it on a moment's notice. Here's the ISBN:
ISBN-10: 1604063262
ISBN-13: 978-1604063264
Get to the medical library as soon as you arrive in town for your audition rotation and be put on the reserve list for it or pay the $80 just to have it in your white coat and look serious about this as your career.

Appear to be in the hospital 24/7, dedicated to this field. If this means going to the cafeteria the long way past a few of the nursing pods or ICU every few hours to pick up a bag of chips or carton of milk, do it. Your day off will be your most dressed up day and you'll do quick "fly-bys" on your patient list from the day before. This is gunner-central and the students that say they've got a day off will be the ones with ink on the chart on their day off and get called in to do emergency cases.

Do not EVER yawn while on service. Your superiors have been there longer than you doing lightning rounds because their surgeries took some extra time or they got hit with a multiple MVA and everyone else is still on their way in. If you're their in that time, you will be "leaded" all the way up to your neck and first-assisting until everyone else gets there.

Arrive an hour before any other students are expected to be there and begin reviewing films and labs for the pre-ops for that day. The words supratentorial and infratentorial should be in your back pocket for any films that may come up for that day.

Know what a neurodiagnostic tech does and learn enough to "become" him when you're in the OR but not directly scrubbed in.

Families are absolutely destroyed when they see what shape the patients on your service are in. Be careful not to overstep what an attending needs to tell them but be firm that everyone must leave the room when you do your morning neuro exam because some of the advanced stuff you do will make it worse if they have to watch you hurt their father or daughter with pins and needles to get an accurate status.

I hope that this is helpful and I thank the neurosurgeon in training again for is input into this fascinating specialty.

Ehh... I don't know about all that.

1) You do NOT have to do an away rotation at a program to get accepted. You should do at least two sub-internships. If you're interviewing at 15 programs you're more likely than not to get into a program where you didn't do a sub-internship.

2) This walking to the cafeteria the "long way" statement sounds pretty pathological...

 

[JGimpel]

.

 

[ijn]

You're welcome for the time I put into making a genuine contribution to this thread. There's stirring the pot, but that usually comes after someone spoils an otherwise good pot of coffee or, in this case, a great thread. I'm going to skip the link to wikipedia on what pathology actually means (Goljan and Sattar should be your primary sources for this anyways) and refrain from putting Latin words alluding to logic (or your lack thereof) in my post to seem more knowledgeable on the subject (this is SDN, it happens.)

1) We're still talking about getting a residency in neurosurgery, right? A sub-internship usually IS an away rotation that may or may not be counted as an "audition" rotation and you have to make the most of every minute to get the right people's attention. If you don't rotate there and show what your hands and quick wit can do, they'll try and save you a drive/plane trip for an interview.
2) Please see #1. As was once said in a Hollywood classic, "Always Be Closing!"

Please add your experience(s) on a neurosurgery service so we can truly compare notes. You are on said service or have been on one by now, right? Otherwise, exercise your frontal lobe more often as the absence of it's effects are definitely apparent today.

do you stare at yourself in the mirror in your free time admiring how amazing you are at being amazing? your crazy is showing.

you have to work hard on an away rotation, but give me a ****ing break. the way you are presenting it you have to be the second coming of jesus christ to get into a neurosurgery program somewhere. that simply is not the case. tons of people every year get into neurosurgery programs without having done an away rotation at the institution they were accepted at. and they didn't engage in bull**** like appearing to be at the hospital 24/7 and making the nursing staff think you're really busy by walking through their departments when you had no good reason to be there.

 

[JGimpel]

.

 

[Bangersandmash]

This has really been an outstanding thread and I applaud neusu for giving of his time when he has absolutely none. I'm not a resident in this specialty, but these are things I picked up along the way:

You must do an audition in neuro or general surgery at the location you want to train at. If it's a level 1 or level 2 trauma center, that's the most ideal.

You need to be able to do a full, attending-level neuro-exam on a patient every morning. A GCS score and deviation from it on your most acute cases should be known before your attending rounds. Know that an 11T means that they're intubated and anything above or below that needs to have a clinical context and a prognosis behind it. Account for propofol if they're on a continuous drip of it. You don't have to come up with this score all of the time, but if you can aid in getting it, you may be solicited for an interview if they know you're "auditioning."

You are not required to buy or memorize the "Greenberg book," but you will need to know where all of the most important bread and butter information can be found in it on a moment's notice. Here's the ISBN:
ISBN-10: 1604063262
ISBN-13: 978-1604063264
Get to the medical library as soon as you arrive in town for your audition rotation and be put on the reserve list for it or pay the $80 just to have it in your white coat and look serious about this as your career.

Appear to be in the hospital 24/7, dedicated to this field. If this means going to the cafeteria the long way past a few of the nursing pods or ICU every few hours to pick up a bag of chips or carton of milk, do it. Your day off will be your most dressed up day and you'll do quick "fly-bys" on your patient list from the day before. This is gunner-central and the students that say they've got a day off will be the ones with ink on the chart on their day off and get called in to do emergency cases.

Do not EVER yawn while on service. Your superiors have been there longer than you doing lightning rounds because their surgeries took some extra time or they got hit with a multiple MVA and everyone else is still on their way in. If you're there in that time, you will be "leaded" all the way up to your neck and first-assisting until everyone else gets there.

Arrive an hour before any other students are expected to be there and begin reviewing films and labs for the pre-ops for that day. The words supratentorial and infratentorial should be in your back pocket for any films that may come up for that day.

Know what a neurodiagnostic tech does and learn enough to "become" him when you're in the OR but not directly scrubbed in.

Families are absolutely destroyed when they see what shape the patients on your service are in. Be careful not to overstep what an attending needs to tell them but be firm that everyone must leave the room when you do your morning neuro exam because some of the advanced stuff you do will make it worse if they have to watch you hurt their father or daughter with pins and needles to get an accurate status.

I hope that this is helpful and I thank the neurosurgeon in training again for is input into this fascinating specialty.

Are you a surgical resident? Your attitude is stereotypical of all the jokes made about surgeons and if you are in a surgical residency, your attitude certainly does good-natured surgeons an injustice.

It could be possible that you know something about neurosurgery residencies, but you said yourself you are not training to be a neurosurgeon. Neusu on the other hand is and his demeanor in disseminating information or answering questions is 1000 times better than yours.

I don't give a rat's ass if neusu knew half of what you knew about neurosurgery (but I'm going to make an assumption he knows twice as much). I wouldn't listen to you because you come off as a prick.

 

[ijn]

I think it's pretty obvious I have a fair amount of day to day experience in this area. I asked you to contribute yours and you have yet to do so. If you have never been selected to do a neurosurgery rotation after a review of your academic stats (you can't just walk into them) then there is no way you can comment on this. It's people like you that will pick apart one small part of a person's actual experience and make him regret even posting here. I'm good because I deal with the occasional high-school kid with an account on SDN, but you may not get the same response from a person actually in training for this specialty. I think that the work neurosurgeons do is amazing, how they can go from macro with basic surgery techniques to micro with spine reconstructions or difficult craniotomies.

In summary for your short attention span, it doesn't look like you even made it through my entire post, post YOUR experience in neurosurgery or drop the attitude because you don't agree with what my experience has been. It happened, it really, really happened... I really hope that neusu will ignore your posts and still come by to give us more of his input. I wish SDN would use RealID or something like it so we cut down on the kids that just got their driver's license and Internet privileges on the same day at their parent's house and figured they'd come here and ruffle a few feathers because they just "know" they will be a doctor. Almost 1000 posts and still behaving like a lost undergrad, I can't wait for you to get a real "education" when you start rotations in 2 years.

Clearly you don't understand VSAS if you think getting a sub-internship is some hyper-competitive process. If you wanted to do a neurosurgery sub-internship you could get one with a 200 on STEP 1 and pure passes for the first two and a half years of medical school. Especially after ERAS deadlines have occurred. Really the most important qualifications are 1) do you have proof of your vaccinations and 2) sufficient malpractice coverage?

 

[JGimpel]

.

 

[mcloaf]

Lot's of jokes and laughter indeed, but none of you two jokers wants to volunteer his experience in this field. I see no reason to keep this from the rest of us. You can look through my posts and you will see that I do my best to help people benefit from my experience, but when they start calling BS in a rude way about a subject they know nothing about, I can return in kind with far more civility as well as additional knowledge about said topic. Thousands of people coming through here and only two trolls, I'm not doing too bad.

I'm calling BS on both of you, prove where you're coming from and let the people coming through decide for themselves who and what to believe. No "friend of a friend" stuff either. I keep trying to help you 1st years by giving you tips on what not to do but you two deserve to find out all of this for yourselves. Show me the paperwork you had to fill out, PM me a blank one so your name isn't on it, to get into your Neurosurgery rotation and I'll either call BS one more time or agree that you've been on one but don't want to offer anything constructive to the conversation. Up to you, but don't waste any more of people's time just jabbering about one person, I truly am not that important or omniscient, make it work for the others genuinely interested in learning how to be successful in this field.

Can we please end this thread hijack and let neusu answer questions again? You guys can argue over PM.

 

[487806]

Can we please end this thread hijack and let neusu answer questions again? You guys can argue over PM.

👍 Too sophisticated arguments...

 

[neusu]

Hmm. I know you've stated above that wet bench work is often considered more legit than paper-based stuff; does this mean that something like a Master's in Clinical Research would be more or less a waste of time in terms of any benefits for applying to neurosurgical residency programs?

As a rule, real bench or clinical research experience is preferable to a structured degree program. Most of these programs have some sort of requirement, but this is neither as long standing nor as intensive as being a part of a group conducting a study. I'd recommend finding a group that has a study you can work on and bypass the degree. If you can do it in addition, that's great, but don't do it in place of a real research experience.

 

[neusu]

Is MGH really that awesome?

Sent from my SGH-T999 using SDN Mobile

It's not "Man's Greatest Hospital" for no reason, now, is it?

 

[neusu]

This is going to be one of the stupidest questions on this thread, but as a resident, do you get any hospital perks? Like free food from the cafeteria?

This, actually, is a great question. To be honest, it was one that I was very interested in as an applicant. Perhaps, I was jealous of my college classmates in business who were getting car service and dinner on the company if they work late, but nonetheless it's nice to know you have a meal ready and waiting if you're available to eat it. So, sorry to be redundant, but again, this varies by hospital. My program gives us free parking in the downtown area, free food, loupes, conferences etc. We also get white coats and scrubs (obviously). Some programs are more frugal while others are more luxurious. Some programs allow moonlighting and others pay residents to do particular things (e.g. dictations). Regardless, as a resident life will not be in the fast-lane. Nonetheless, if you normally eat $200/month in food and can cut that to $100, you are making an extra $1,200/year before taxes if they supply some/any/all meals.

 

[neusu]

yo neusu,

apologies if you've already answered these....slightly sleep deprived

1. are there travel opportunities? --> specifically i. i'm sure you can still do doctors without borders/etc right? ii. how do you travel for conferences? iii. can you do a research fellowship (in neuroscience/neurosurg) in europe/aus? iv. do you know anyone now practicing in europe/aus?

2. how late is too late to go into neuro? i mean what if you had no interest in neurosurg till your rotation 3rd year...given excellent scores+grades can you still manage a quick/start on a research project between 3rd and 4th year and be competitive for a decent program?

3. any info on what ped neurosurgery is like?

4. I think you mentioned that in private practice your vacation really depends on the group/structure right? what's the average, 4wks?

5. did any of your colleagues do research in cognitive computing/artificial intelligence

thanks man.

Apologies if my answer is rambling or doesn't make sense... always sleep deprived

1. I touched on this before, but many programs specifically have a foreign component (UVA, VCU, Wash U, etc.). If your program doesn't, you may be able to spend some time abroad with FIENS (Foundation for International Education in Neurological Surgery) during your elective years or ask your program to allow you to spend time in some place in particular. Following graduation, there are multitude options with health volunteers overseas etc. for getting involved where needed. As I mentioned previously, a lot of what we do requires a lot of ancillary staff or capital outlay for CT/MRI scanners etc. It's harder to parachute in to the Brazillian jungle and start to do lumbar discs or brain tumors than cleft palates.
2. There isn't a hard-line on the too late. Some people figure it out after they complete one residency (see the examples of neurologists or orthopaedists who subsequently do neurosurgery). That being said, the earlier you can find out, the better. If it's late 3rd year or early 4th year, you aren't too late. Depending on your scores you may need to delay your application by a year since ERAS comes out rather early etc but it is still very feasible. I talk to kids every June on their neurosurgery rotation during surgery who decide they love it and go all-in and need advice. Most of them have matched, so don't worry if you find the bug late.
3. We, like every program, have a peds component, so I am very familiar with the specialty. Perhaps it's my bias, as I'm not terribly interested in peds, but it seems to be a lot of shunts and postop tumor/myelo patients who hang around forever. I love working with the kids but being the parent handler sometimes can be a pain, nonetheless peds is far more attractive than pain patients. Overall, peds neurosurgeons tend to get paid less than their counterparts aside from pedi-spine scoli specialists. They also tend to work some very long hours and have to deal with more family drama than the adult attendings
4. Private practice vacation is quite variable. I can't say for certain, but I think 4 weeks would be an absolute low limit and more like 6-8 weeks plus educational/conference time. This again depends on the practice. If you are in solo practice, you don't really ever get a vacation.
5. Not sure what you mean by "cognitive computing" but I'll assume you mean either machine:brain interfaces or computational learning. We are involved in both fields. The former, basically, trying to understand the neural circuitry at a level that we can create an interface with a computer to read brain signals and create an appropriate response. The latter, creating algorithms using our understanding of signal integration and checking in neurons to model software to understand large, complex data sets. With the recent advances in technology the next 20 years will be amazing with respect to our ability to both understand data and create systems for neural integration.

 

[pgoyal]

sold! thnx.

5. Not sure what you mean by "cognitive computing" but I'll assume you mean either machine:brain interfaces or computational learning. We are involved in both fields. The former, basically, trying to understand the neural circuitry at a level that we can create an interface with a computer to read brain signals and create an appropriate response. The latter, creating algorithms using our understanding of signal integration and checking in neurons to model software to understand large, complex data sets. With the recent advances in technology the next 20 years will be amazing with respect to our ability to both understand data and create systems for neural integration.

 

[572776]

Would you say that having research/pubs is more important than grades during the first two years? My school is on the Gpa and not the P/F/H grading system. Is 3.0+research > 3.7 and no research, or the other way around?

Thank you!🙂

 

[deleted393595]

5. Not sure what you mean by "cognitive computing" but I'll assume you mean either machine:brain interfaces or computational learning. We are involved in both fields. The former, basically, trying to understand the neural circuitry at a level that we can create an interface with a computer to read brain signals and create an appropriate response. The latter, creating algorithms using our understanding of signal integration and checking in neurons to model software to understand large, complex data sets. With the recent advances in technology the next 20 years will be amazing with respect to our ability to both understand data and create systems for neural integration.

Thanks a lot for sacrificing your sleep and sanity to answer our questions! We really appreciate it!

In regards to reading brain signals, are you'll using solely EEG or ECOG or LFP or Single-Cell or a combo of them?

 

[neusu]

Would you say that having research/pubs is more important than grades during the first two years? My school is on the Gpa and not the P/F/H grading system. Is 3.0+research > 3.7 and no research, or the other way around?

Thank you!🙂

I would have liked to think so, but alas it seems that again grades and scores are the metric by which everyone is judged. If your school is on the GPA scale, do your best to keep your GPA as high as possible. Also, score as high as possible on Step 1. No amount of research by itself will overcome a terrible Step 1 and/or horrible grades. The caveat is that having strong research typically portends to a good relationship with your department and possibly an inside connection.

 

[neusu]

Thanks a lot for sacrificing your sleep and sanity to answer our questions! We really appreciate it!

In regards to reading brain signals, are you'll using solely EEG or ECOG or LFP or Single-Cell or a combo of them?

Depends on the environment and indication. For epilepsy we'll often do EEG, ECOG, or an array of single cell recording. For DBS we'll do LFP or single-cell. We also do fMRI and other functional imaging modalities.

 

[stronghold]

Sweet! I am man who is married but want to have a great operative experience. I want to ask about strong programs that are friendly. Could you provide me with info about those programs?

 

[neusu]

Sweet! I am man who is married but want to have a great operative experience. I want to ask about strong programs that are friendly. Could you provide me with info about those programs?

The notion about strong and weak programs is rather silly. Neurosurgery is a 7-year training program. I can guarantee that things will be different in the department when you are chief from when you are intern. A currently strong program could have an exodus of staff and become a weak program. A weak program could hire a strong chairman with good foresight and vision and create the next top program.

Do the best you can in school, get the best scores you can, apply broadly, go on interviews, take notes. At the end of the season, see which program fits your personality, preferences, and needs best and make your rank list accordingly. If you prepared well, it is more than likely you will match at the top of your personal strong program list.

 

[Dick Jones]

I apologize if these questions have been asked before. What are the best med schools that have the highest number of neurosurgery matches? Also, what score on Step 1 guarantees matching into neurosurgery?