MD Completing Two Surgical Residencies: Orthopedics and Neurosurgery

[anab21]

I actually found a surgeon who has done this. My question is, do you get dropped into the middle of the second residency or do you start at the beginning and have to do all 5-7 years?

Lets say you did orthopedics first and then did a spine fellowship(they have spine fellowships where you learn both orth/neuro style spine surgeries). You now can do 50% of of what a neurosurgeon can do-neuro spine. So for the second residency (neurosurgery) do you get advanced placement into the surgerical years PGY-6 and PGY-7?

A different question: Without even doing the second residency in neurosurgery, just ortho residency and spine fellowship: can you take the boards for neurosurgery-since your are trained in do neuro-spine style surgery?

If your spine fellowship trains you in neuro spine (entering the dura) can you take neurosurgery boards without doing neurosurgey residency?

Christopher Shaffrey, MD | Neurosciences | UVA

Christopher I Shaffrey, MD, FACS graduated magna cum laude from The Citadel in 1982 with B.S. degree in Biology. He played varsity basketball and was the co-captain his senior year. In 1986, Dr. Shaffrey received his medical degree from the University of Virginia. He completed his general surgical internship at Naval Hospital San Diego in 1987 where he was named the surgical intern of the year. He completed both neurosurgical and orthopaedics residencies at the University of Virginia. A spine fellowship in pediatric and adult reconstructive spine surgery was completed in 1995.

Following completion of his surgical training he was appointed to the senior staff in the Departments of Neurological Surgery and Orthopaedic Surgery at Henry Ford Hospital where he was actively involved in treating members of Detroit’s college and professional athletic teams. In 1999, Dr. Shaffrey was appointed Associate Professor of Neurological Surgery and Adjunct Associate Professor of Orthopaedic Surgery and Sports Medicine at the University of Washington in Seattle. In 2003, he returned to the University of Virginia as Professor of Neurological Surgery and Director of the Neurosurgery Spine Division. In 2008, he was named Harrison Distinguished Teaching Professor of Neurological and Orthopaedic Surgery. In 2013, Dr. Shaffrey was named the John A. Jane Professor of Neurological Surgery. Dr. Shaffrey is board certified in the fields of Neurological Surgery and Orthopaedic Surgery.

Burak M. Ozgur, MD

Burak M. Ozgur, MD is a neurosurgeon at the Cedars-Sinai Spine Center. He is double board-certified by the American Board of Neurological Surgery and the American Board of Spine Surgery and is fellowship trained in combined spinal neurosurgery and orthopaedic spine surgery. Dr. Ozgur specializes in spinal surgery: spinal cord tumors, spinal trauma, complex instrumentation and minimally invasive spine surgery. He has a strong interest in leading-edge minimally-invasive spine surgery development and research.

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[masaraksh]

"neuro-spine style surgery". Can you do Gangnam-spine style surgery

 

[libertyyne]

1.From my understanding acgme provides funding and for residency programs and will cut you off after the duration of the initial residency . So you will have to pay out of pocket after the initial residency.
2. You might have issues keeping up competencies in both specialties.
3. You should focus on getting into medical school before settling on grandiose specialties. This might be a more fruitful discussion after you take step one and with the counselors at your school.(based on your profile)

 

[ACSurgeon]

I actually found a surgeon who has done this. My question is, do you get dropped into the middle of the second residency or do you start at the beginning and have to do all 5-7 years?

Lets say you did orthopedics first and then did a spine fellowship(they have spine fellowships where you learn both orth/neuro style spine surgeries). You now can do 50% of of what a neurosurgeon can do-neuro spine. So for the second residency (neurosurgery) do you get advanced placement into the surgerical years PGY-6 and PGY-7?

A different question: Without even doing the second residency in neurosurgery, just ortho residency and spine fellowship: can you take the boards for neurosurgery-since your are trained in do neuro-spine style surgery?

If your spine fellowship trains you in neuro spine (entering the dura) can you take neurosurgery boards without doing neurosurgey residency?

Christopher Shaffrey, MD | Neurosciences | UVA


Burak M. Ozgur, MD

Reality is most orthopedic surgeons don't practice the full breadth of ortho that they were trained for in residency. Same for neurosurgery. So, doing both residencies is a waste of time because it's impossible to practice the full breadth of specialty, let alone two

 

[ERDOC555]

I actually found a surgeon who has done this. My question is, do you get dropped into the middle of the second residency or do you start at the beginning and have to do all 5-7 years?

Lets say you did orthopedics first and then did a spine fellowship(they have spine fellowships where you learn both orth/neuro style spine surgeries). You now can do 50% of of what a neurosurgeon can do-neuro spine. So for the second residency (neurosurgery) do you get advanced placement into the surgerical years PGY-6 and PGY-7?

A different question: Without even doing the second residency in neurosurgery, just ortho residency and spine fellowship: can you take the boards for neurosurgery-since your are trained in do neuro-spine style surgery?

If your spine fellowship trains you in neuro spine (entering the dura) can you take neurosurgery boards without doing neurosurgey residency?

Christopher Shaffrey, MD | Neurosciences | UVA


Burak M. Ozgur, MD

Oh dear god, not this again.
Neurosurgery - Cardiac Surgery Combined

The short answer is that nothing like this would happen in 2017. At best you could complete or drop out of one surgical residency and then (against all odds) match into and start a whole new surgical residency and then practice solely in that field. Surgical training is too long and too specialized to ever practice in two unrelated fields.

 

[libertyyne]

1 is not true. Your funding comes from Medicare first off, not the ACGME. It is limited based on the number of years of your specialty (or original specialty if you switch, which is when this usually comes up as an issue). But after your reach the limited number of years, what happens is that your hospital receives slightly less funding from Medicare, not NO funding at all. And you definitely do not have to self pay when that happens; in fact you are not allowed to self pay for a residency (as this would create obvious conflict of issues/disparities)

Thanks For the clarification. I misattributed the funding source. By self pay, I meant working for free not paying for the actual spot. Are programs willing to go through the hassle of actually allowing someone to come back for a second residency ?

I know a medical school dean who did a fm residency and then went back to do obgyn. Another doc I know did for and went back for em. I just assumed that the funding mechanisms have changed since then.

 

[libertyyne]

You also can't work for free, for the same reason

I was basing my assumption on the following article I read. Maybe rules have changed?
Job Prospects Are Dimming for Radiology Trainees

"One hospital, McLaren Macomb, in suburban Detroit, instead offered several residents slots in its “unfunded program,” in which most radiology residents essentially pay for their own positions through donations, typically from a spouse or parents: $65,000 a year to cover a $42,000 salary and $2,000 for expenses."

 

[IlDestriero]

Just do Neuro and a spine fellowship.


--
Il Destriero

 

[AZDev]

I also have an interest in this. I'm only interested in some aspects of both neuro and ortho surgery. My interest is primarily around disabilities of many varieties, prosthetics, neural interface implantation, and myoelectric implant procedures. In particular, I have a strong interest in bioelectronic medicines of many kinds. I would imagine having experience in both neurological and orthopedic surgery would be necessary or at least very useful to do procedures in both aspects of this myself without having to partner with someone else in the other specialty.

I've done a lot of reading about this topic. I've searched SDN, I've read through various residency pages and about the procedures taught in different ones, I've communicated with people on other online sources like reddit, Discord, and so on.

What I've found, overall, is the following:
- There do not appear to be any existing combined residency programs that support this sort of training (at least none that I could find on a cursory google search, on the residency databases, or by talking to other people), thereby, you'd either need to do residencies in succession (at your own detriment and potentially try to moonlight in one while training in the other assuming your residency program will allow it) or you'd need to find a program which supports integration of both residency trainings into your lifestyle.
- Dr. Shaffrey's training appears to have been general surgery in parallel with neurological surgery for the first two years and for the last 5 orthopedic surgery in parallel with neurosurgery. I have only ever heard of dual residencies with neurological surgery out of UVA. In fact, I noticed that one of the only two physicians in the country dual trained in pediatric and neurological surgery residencies came out of UVA. That being said, I wonder if this is genuinely a unique UVA thing, or something that could be arranged at other organizations, or just evidence of past opportunities that may no longer exist. I see no evidence of any such program existing, at least not officially, at UVA, despite the existence of such individuals so I figure that either this is a case-by-case situation which you'd need to communicate with them about or at least plan around OR this is a program that no longer exists there.
- I have not yet fully explored the possibility of training like this existing overseas as I'd prefer to remain in the USA if possible, though it is possible something like this exists overseas somewhere but you might need to get training specific to that country in medicine depending on where it is, which might be undesirable to others interested in this.

That all being said, there are mainly two types of things I am primarily interested in being able to do:
- musculoskeletal procedures involving implanted devices
- peripheral nerve / central nervous system surgeries for implantation of neural interfaces or or the external attachment thereof

I'm wondering if there is a way to be able to do these things without dual residency training. Does anyone have any suggestions? I have not been able to come up with a reasonable solution yet. Similar to OP, I am not looking for people to convince to not do the thing I am trying to do. If you have suggestions on how I could achieve this, I welcome them, but I do not have any interest in changing my path. If I have to take a cut in pay or anything else, I will. I just want to figure out how this might work.

 

[libertyyne]

I also have an interest in this. I'm only interested in some aspects of both neuro and ortho surgery. My interest is primarily around disabilities of many varieties, prosthetics, neural interface implantation, and myoelectric implant procedures. In particular, I have a strong interest in bioelectronic medicines of many kinds. I would imagine having experience in both neurological and orthopedic surgery would be necessary or at least very useful to do procedures in both aspects of this myself without having to partner with someone else in the other specialty.

I've done a lot of reading about this topic. I've searched SDN, I've read through various residency pages and about the procedures taught in different ones, I've communicated with people on other online sources like reddit, Discord, and so on.

What I've found, overall, is the following:
- There do not appear to be any existing combined residency programs that support this sort of training (at least none that I could find on a cursory google search, on the residency databases, or by talking to other people), thereby, you'd either need to do residencies in succession (at your own detriment and potentially try to moonlight in one while training in the other assuming your residency program will allow it) or you'd need to find a program which supports integration of both residency trainings into your lifestyle.
- Dr. Shaffrey's training appears to have been general surgery in parallel with neurological surgery for the first two years and for the last 5 orthopedic surgery in parallel with neurosurgery. I have only ever heard of dual residencies with neurological surgery out of UVA. In fact, I noticed that one of the only two physicians in the country dual trained in pediatric and neurological surgery residencies came out of UVA. That being said, I wonder if this is genuinely a unique UVA thing, or something that could be arranged at other organizations, or just evidence of past opportunities that may no longer exist. I see no evidence of any such program existing, at least not officially, at UVA, despite the existence of such individuals so I figure that either this is a case-by-case situation which you'd need to communicate with them about or at least plan around OR this is a program that no longer exists there.
- I have not yet fully explored the possibility of training like this existing overseas as I'd prefer to remain in the USA if possible, though it is possible something like this exists overseas somewhere but you might need to get training specific to that country in medicine depending on where it is, which might be undesirable to others interested in this.

That all being said, there are mainly two types of things I am primarily interested in being able to do:
- musculoskeletal procedures involving implanted devices
- peripheral nerve / central nervous system surgeries for implantation of neural interfaces or or the external attachment thereof

I'm wondering if there is a way to be able to do these things without dual residency training. Does anyone have any suggestions? I have not been able to come up with a reasonable solution yet. Similar to OP, I am not looking for people to convince to not do the thing I am trying to do. If you have suggestions on how I could achieve this, I welcome them, but I do not have any interest in changing my path. If I have to take a cut in pay or anything else, I will. I just want to figure out how this might work.

What exactly do you mean by msk procedures involving implanted devices?

 

[AZDev]

What exactly do you mean by msk (musculoskeletal?) procedures involving implanted devices?

Here are a few examples:
1. Osseointegration: Osseointegration Limb Replacement: More Control for Amputees
"Bone-anchored prostheses have been shown to lead to better patient outcomes than standard, socket-based prostheses. An osseointegrated prosthetic limb reduces or eliminates common problems associated with sockets, including:

• pinching
• sweating
• poor fit or need for frequent refitting
• poor ability to control the prosthesis
• lack of patient confidence due to mobility challenges
• nerve pain
• skin, irritation, sores and ulcers

In traditional prosthetic leg systems, there can be a poor fit between the residual limb and the socket. Many patients experience significant changes in the size and shape of their residual limb during the first 12 to 18 months after amputation surgery."

2. Targeted Muscle Reinnervation (TMR) - Arguably either plastic / ortho surgery

Reconstructive Surgery

The reconstructive surgeons at Johns Hopkins specialize in a range of reconstructive surgeries including breast reconstruction, cleft lip and palate, craniosynostosis, burns, and lymphedema treatment.

www.hopkinsmedicine.org

Targeted Muscle Reinnervation and Advanced Prosthetic Arms

Targeted muscle reinnervation (TMR) is a surgical procedure used to improve the control of upper limb prostheses. Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their function. These ...

www.ncbi.nlm.nih.gov

Targeted Muscle Reinnervation | Florida Orthopaedic Institute

Targeted Muscle Reinnervation (TMR) is a procedure for arm amputees that allows for elbow, wrist, and hand movements. Call FOI to schedule an appointment!

www.floridaortho.com

"After TMR, the patient can get fitted for a myoelectric-controlled prosthesis – an externally powered artificial limb controlled with the electrical signals generated naturally by your own muscles. Until the prosthesis is ready, the patient can wear their regular prosthesis. To use the prosthesis, the patient will have to go through focused rehabilitation that involves coordinative and neuromuscular training. Rehabilitation teaches patients how to use the prosthesis as well as helps with the healing process."

3. Various reconstructive surgeries involving mechanical implants which are common to orthopedic surgery residencies, AFAIK.

I am also interested in reconstructive hand and upper extremity surgeries (with respect to prosthetics, I'd prefer to focus on the upper extremity as opposed to the lower extremity, though I do have some interest in the lower extremity; I have observed some hand surgeries in person before). For this reason, I'm considering the Hand and Upper Extremity fellowships as one of a few potential future fellowships (which I would need ortho for).

I believe there are also specific fellowships for both spine surgery and CNS surgery, but the Peripheral Nerve Surgery fellowship program from Mayo Clinic seems much more up my alley on the neuro side than a spine fellowship would since it specifically involves techniques which would be more useful in my subject area.

Peripheral Nerve Surgery Fellowship (Minnesota) - Residencies and Fellowships - Mayo Clinic College of Medicine & Science

Mayo Clinic School of Graduate Medical Education offers the one-year Peripheral Nerve Surgery Fellowship at its campus in Rochester, Minnesota.

college.mayo.edu

I know they're extremely selective though so I'm not holding out hope that this is my only option and am open to looking at other paths that might work. That being said, since they accept orthosurgeons to the PNS fellowship, I could feasibly train in those procedures without the neurosurgery background but this would not give me the necessary background for central nervous system procedures which I would need a neurosurgical residency for.

I have research interests in sensory restoration for prosthetic upper extremity devices by using peripheral nerve stimulation via microelectrodes. For some examples, there is MIT's Biomechatronics Lab's AMI Interface and the Case Western Functional Neural Interface Lab's FINE electrode for pressure perception. In the future, I'd also like to have the flexibility to explore central nervous system approaches these problems which are also being investigated (see Johns Hopkins University Applied Physics Lab's Modular Prosthetic Limb for an example).

 

[VincentAdultman]

Here are a few examples:
1. Osseointegration: Osseointegration Limb Replacement: More Control for Amputees
"Bone-anchored prostheses have been shown to lead to better patient outcomes than standard, socket-based prostheses. An osseointegrated prosthetic limb reduces or eliminates common problems associated with sockets, including:

• pinching
• sweating
• poor fit or need for frequent refitting
• poor ability to control the prosthesis
• lack of patient confidence due to mobility challenges
• nerve pain
• skin, irritation, sores and ulcers

In traditional prosthetic leg systems, there can be a poor fit between the residual limb and the socket. Many patients experience significant changes in the size and shape of their residual limb during the first 12 to 18 months after amputation surgery."

2. Targeted Muscle Reinnervation (TMR) - Arguably either plastic / ortho surgery

Reconstructive Surgery

The reconstructive surgeons at Johns Hopkins specialize in a range of reconstructive surgeries including breast reconstruction, cleft lip and palate, craniosynostosis, burns, and lymphedema treatment.

www.hopkinsmedicine.org

Targeted Muscle Reinnervation and Advanced Prosthetic Arms

Targeted muscle reinnervation (TMR) is a surgical procedure used to improve the control of upper limb prostheses. Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their function. These ...

www.ncbi.nlm.nih.gov

Targeted Muscle Reinnervation | Florida Orthopaedic Institute

Targeted Muscle Reinnervation (TMR) is a procedure for arm amputees that allows for elbow, wrist, and hand movements. Call FOI to schedule an appointment!

www.floridaortho.com

"After TMR, the patient can get fitted for a myoelectric-controlled prosthesis – an externally powered artificial limb controlled with the electrical signals generated naturally by your own muscles. Until the prosthesis is ready, the patient can wear their regular prosthesis. To use the prosthesis, the patient will have to go through focused rehabilitation that involves coordinative and neuromuscular training. Rehabilitation teaches patients how to use the prosthesis as well as helps with the healing process."

3. Various reconstructive surgeries involving mechanical implants which are common to orthopedic surgery residencies, AFAIK.

I am also interested in reconstructive hand and upper extremity surgeries (with respect to prosthetics, I'd prefer to focus on the upper extremity as opposed to the lower extremity, though I do have some interest in the lower extremity; I have observed some hand surgeries in person before). For this reason, I'm considering the Hand and Upper Extremity fellowships as one of a few potential future fellowships (which I would need ortho for).

I believe there are also specific fellowships for both spine surgery and CNS surgery, but the Peripheral Nerve Surgery fellowship program from Mayo Clinic seems much more up my alley on the neuro side than a spine fellowship would since it specifically involves techniques which would be more useful in my subject area.

Peripheral Nerve Surgery Fellowship (Minnesota) - Residencies and Fellowships - Mayo Clinic College of Medicine & Science

Mayo Clinic School of Graduate Medical Education offers the one-year Peripheral Nerve Surgery Fellowship at its campus in Rochester, Minnesota.

college.mayo.edu

I know they're extremely selective though so I'm not holding out hope that this is my only option and am open to looking at other paths that might work. That being said, since they accept orthosurgeons to the PNS fellowship, I could feasibly train in those procedures without the neurosurgery background but this would not give me the necessary background for central nervous system procedures which I would need a neurosurgical residency for.

I have research interests in sensory restoration for prosthetic upper extremity devices by using peripheral nerve stimulation via microelectrodes. For some examples, there is MIT's Biomechatronics Lab's AMI Interface and the Case Western Functional Neural Interface Lab's FINE electrode for pressure perception. In the future, I'd also like to have the flexibility to explore central nervous system approaches these problems which are also being investigated (see Johns Hopkins University Applied Physics Lab's Modular Prosthetic Limb for an example).

Not to sound like a SDN cliche but I think you need to focus the basics of whether you want to be a neurosurgeon or an orthopedic surgeon before getting into the real cutting edge stuff. I was today years old when I learned that ossointegration for prostheses was a real thing and I am an ACTUAL orthopedic surgeon. Suggesting that stuff like that is done at HSS and few other places in the world.

 

[AZDev]

Not to sound like a SDN cliche but I think you need to focus the basics of whether you want to be a neurosurgeon or an orthopedic surgeon before getting into the real cutting edge stuff. I was today years old when I learned that ossointegration for prostheses was a real thing and I am an ACTUAL orthopedic surgeon. Suggesting that stuff like that is done at HSS and few other places in the world.

Personally, I think I lean ortho on average, but I would not be satisfied if I did not have the necessary training to do the previously mentioned neurological procedures due to their significance in my research of interest. I also have significantly more fascination with neurological surgery and neuroscience in general than with orthopedic surgery. I don't mind lower pay, nor do I mind having to deal with the additional requirement for continuing accreditation.

Also, I love the Bojack Horseman reference. Great show.

 

[cybermed2424]

Not sure if you are in medical school or not yet but I would recommend trying to get into a program that is publishing on your interests.

 

[AZDev]

Not sure if you are in medical school or not yet but I would recommend trying to get into a program that is publishing on your interests.

Not yet. I'm a 2020-2021 applicant. I'm just thinking ahead to plan out my future. I know people say that planning that far ahead can be silly, but I don't like surprises. I really prefer to have a plan in place for my future. I am only planning to apply to schools that have research in my area of interest and I am only applying MD-PhD. I also did research with one of those labs before applying. I'm really hoping it helps with my application, but even with high scores I'm not sure what to expect. Anything could happen.

 

[Detective SnowBucket]

Not to sound like a SDN cliche but I think you need to focus the basics of whether you want to be a neurosurgeon or an orthopedic surgeon before getting into the real cutting edge stuff. I was today years old when I learned that ossointegration for prostheses was a real thing and I am an ACTUAL orthopedic surgeon. Suggesting that stuff like that is done at HSS and few other places in the world.

Lowly M0 but I shadowed an orthopod who was involved with one of these projects through the military (where else can you find a significant population of otherwise very healthy amputees) and it was by no means HSS

 

[AZDev]

Forgive me for not understanding. What do you mean by HSS? At first I thought you were referring to HSS.edu and now I think you mean something along the lines of hyperspecialized specializations or something. Help me understand.

 

[Miles Gloriosus]

Here are a few examples:
1. Osseointegration: Osseointegration Limb Replacement: More Control for Amputees
"Bone-anchored prostheses have been shown to lead to better patient outcomes than standard, socket-based prostheses. An osseointegrated prosthetic limb reduces or eliminates common problems associated with sockets, including:

• pinching
• sweating
• poor fit or need for frequent refitting
• poor ability to control the prosthesis
• lack of patient confidence due to mobility challenges
• nerve pain
• skin, irritation, sores and ulcers

In traditional prosthetic leg systems, there can be a poor fit between the residual limb and the socket. Many patients experience significant changes in the size and shape of their residual limb during the first 12 to 18 months after amputation surgery."

2. Targeted Muscle Reinnervation (TMR) - Arguably either plastic / ortho surgery

Reconstructive Surgery

The reconstructive surgeons at Johns Hopkins specialize in a range of reconstructive surgeries including breast reconstruction, cleft lip and palate, craniosynostosis, burns, and lymphedema treatment.

www.hopkinsmedicine.org

Targeted Muscle Reinnervation and Advanced Prosthetic Arms

Targeted muscle reinnervation (TMR) is a surgical procedure used to improve the control of upper limb prostheses. Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their function. These ...

www.ncbi.nlm.nih.gov

Targeted Muscle Reinnervation | Florida Orthopaedic Institute

Targeted Muscle Reinnervation (TMR) is a procedure for arm amputees that allows for elbow, wrist, and hand movements. Call FOI to schedule an appointment!

www.floridaortho.com

"After TMR, the patient can get fitted for a myoelectric-controlled prosthesis – an externally powered artificial limb controlled with the electrical signals generated naturally by your own muscles. Until the prosthesis is ready, the patient can wear their regular prosthesis. To use the prosthesis, the patient will have to go through focused rehabilitation that involves coordinative and neuromuscular training. Rehabilitation teaches patients how to use the prosthesis as well as helps with the healing process."

3. Various reconstructive surgeries involving mechanical implants which are common to orthopedic surgery residencies, AFAIK.

I am also interested in reconstructive hand and upper extremity surgeries (with respect to prosthetics, I'd prefer to focus on the upper extremity as opposed to the lower extremity, though I do have some interest in the lower extremity; I have observed some hand surgeries in person before). For this reason, I'm considering the Hand and Upper Extremity fellowships as one of a few potential future fellowships (which I would need ortho for).

I believe there are also specific fellowships for both spine surgery and CNS surgery, but the Peripheral Nerve Surgery fellowship program from Mayo Clinic seems much more up my alley on the neuro side than a spine fellowship would since it specifically involves techniques which would be more useful in my subject area.

Peripheral Nerve Surgery Fellowship (Minnesota) - Residencies and Fellowships - Mayo Clinic College of Medicine & Science

Mayo Clinic School of Graduate Medical Education offers the one-year Peripheral Nerve Surgery Fellowship at its campus in Rochester, Minnesota.

college.mayo.edu

I know they're extremely selective though so I'm not holding out hope that this is my only option and am open to looking at other paths that might work. That being said, since they accept orthosurgeons to the PNS fellowship, I could feasibly train in those procedures without the neurosurgery background but this would not give me the necessary background for central nervous system procedures which I would need a neurosurgical residency for.

I have research interests in sensory restoration for prosthetic upper extremity devices by using peripheral nerve stimulation via microelectrodes. For some examples, there is MIT's Biomechatronics Lab's AMI Interface and the Case Western Functional Neural Interface Lab's FINE electrode for pressure perception. In the future, I'd also like to have the flexibility to explore central nervous system approaches these problems which are also being investigated (see Johns Hopkins University Applied Physics Lab's Modular Prosthetic Limb for an example).

Just do ortho residency and a hand surgery fellowship. The only TMRs I see being done are ortho hand and plastics hand surgeons who do nerve transfers.

 

[VincentAdultman]

Forgive me for not understanding. What do you mean by HSS? At first I thought you were referring to HSS.edu and now I think you mean something along the lines of hyperspecialized specializations or something. Help me understand.

Hospital for Special Surgery.

 

[numberwunn]

Not yet. I'm a 2020-2021 applicant. I'm just thinking ahead to plan out my future. I know people say that planning that far ahead can be silly, but I don't like surprises. I really prefer to have a plan in place for my future. I am only planning to apply to schools that have research in my area of interest and I am only applying MD-PhD. I also did research with one of those labs before applying. I'm really hoping it helps with my application, but even with high scores I'm not sure what to expect. Anything could happen.

If you're not even in need school yet there's really no point in going anywhere near this deep down the rabbit hole because you know nothing about what you want right now.

First of all, you have no idea what specialty you want to do. You'll have a better idea after 3rd year. You intellectual interests have nothing to do with what specialty is best for you. I was very interested in cardiac physiology, but found that I despised medicine rounding/ note writing/ etc. I never found orthopedic anatomy etc particularly captivating as an m1 but loved the OR and daily life of an orthopod ... so here I am. You nay find that you despise the OR, or that you don't have good hands. You need to figure that all out first.

Then even if you go into one of those fields ie ortho you may find that you really love doing joints rather than nerve work etc

For now keep an open mind. Learn about everything. Be honest with yourself about your true strengths, weaknesses, desires, etc. Remember that what you want now isn't what you want in 10 years when you have a family just want to be home for supper.

 

[numberwunn]

Lowly M0 but I shadowed an orthopod who was involved with one of these projects through the military (where else can you find a significant population of otherwise very healthy amputees) and it was by no means HSS

Bethesda/ Walter Reed (large military academic center) is one of the sites for osteointegration research. Not sure about where else, but it is still a small number and cutting edge. Very exciting though, saw a presentation about it. Still early though.

Just do ortho residency and a hand surgery fellowship. The only TMRs I see being done are ortho hand and plastics hand surgeons who do nerve transfers.

100% agree. I think the ortho- hand route would give you the best training, they're doing some wild nerve work now with TMR even in BKA etc

 

[AZDev]

If you're not even in need school yet there's really no point in going anywhere near this deep down the rabbit hole because you know nothing about what you want right now.

I'm sorry, but I don't really agree. I have a rough idea of what I want and am trying to clarify how to learn it.

First of all, you have no idea what specialty you want to do. You'll have a better idea after 3rd year. You intellectual interests have nothing to do with what specialty is best for you. I was very interested in cardiac physiology, but found that I despised medicine rounding/ note writing/ etc. I never found orthopedic anatomy etc particularly captivating as an m1 but loved the OR and daily life of an orthopod ... so here I am. You nay find that you despise the OR, or that you don't have good hands. You need to figure that all out first.

I shadowed an orthopedic surgeon in office, in surgery, and during pretty much everything he did during the day. He'd even quiz me on things relating to the topic.

I can deal with whatever BS is thrown at me. That all being said, I am open to learning about the other specialties more, however, I've grown quite certain about what I want. If that changes in the future, then so be it, but I, quite strongly, doubt it.

Then even if you go into one of those fields ie ortho you may find that you really love doing joints rather than nerve work etc

I do have some interest in joints actually (I've watched some stuff related to the subject); that being said, nerves, bones, and muscles are more my jam, tbh.

For now keep an open mind. Learn about everything. Be honest with yourself about your true strengths, weaknesses, desires, etc. Remember that what you want now isn't what you want in 10 years when you have a family just want to be home for supper.

Right now I don't have the burden of a family so that's the last thing that is on my mind. I care more about being able to figure out how to achieve my professional goals for the time being. That being said, if something comes up, I can always plan around that. That's why I plan; I don't do it to know exactly where I will be, but rather, I do it to figure out where I could be, how I could get there, and what it will take. You can't say for sure that my plans will change 10 years from now, even if it is statistically likely. It is extremely rare that I remove an ambition from my life and much more likely that I add another one.

 

[AZDev]

Bethesda/ Walter Reed (large military academic center) is one of the sites for osteointegration research. Not sure about where else, but it is still a small number and cutting edge. Very exciting though, saw a presentation about it. Still early though.

Didn't know about this! Thanks for pointing it out!

100% agree. I think the ortho- hand route would give you the best training, they're doing some wild nerve work now with TMR even in BKA etc

I was leaning towards this (I'm probably biased because I shadowed a pretty cool hand specialist) but I really feel like the peripheral nerve training, at the very minimum, will be necessary for me. That being said, the central nervous system procedure training also feels necessary. I really wish there was an easier way I could get these skills than dual residencies but I just can't come up with a better solution right now.

 

[DarkHorizon]

(Edited by staff for content). It’s cool that you have all these interest but doing an orthopedic and neurosurgery residency both sounds like medieval torture. I do believe that a handful of people have done this but still don’t understand why anyone would want to. There’s no way you can keep up with the breadth of procedures in both fields competently and do them safely. I am an orthopod and am fairly well specialized and don’t dabble into things that I don’t do routinely anymore, even though I did them hundreds of times in training.

 

[yugimuto]

I can deal with whatever BS is thrown at me. That all being said, I am open to learning about the other specialties more, however, I've grown quite certain about what I want. If that changes in the future, then so be it, but I, quite strongly, doubt it.

I thought I could handle any BS thrown at me too. Then I entered med school and realized that it takes a certain person to be able to endure a very long residency after you receive your MD. Your current plan seems really long, tiring, and emotionally exhausting.
I thought I could handle a grueling specialty and had an interest in neurosurgery and wanted to have the most intense possible career. Just after one year did I realize I would love a lifestyle specialty where I could focus time on my other interests. Interests really do change, and I'm glad I found this out early.

For now keep an open mind. Learn about everything. Be honest with yourself about your true strengths, weaknesses, desires, etc. Remember that what you want now isn't what you want in 10 years when you have a family just want to be home for supper.

There's a reason why s/he is a resident. Keep an open mind when you are young and really try to appreciate the advice that people give you. It's better to explore and learn at an early age.

Also more than anything else, less is more. Why not just focus your energy on one of the specialties and be the best doc/researcher you can be? There's only so much that you can be trained for. You have strong interests in research - how are you going to be able to do all the crazy long surgeries and procedures and be a productive academic on the side?

And remember that the cutting edge stuff is not necessarily what the bread/butter of a specialty is.

 

[AZDev]

There’s no way you can keep up with the breadth of procedures in both fields competently and do them safely. I am an orthopod and am fairly well specialized and don’t dabble into things that I don’t do routinely anymore, even though I did them hundreds of times in training.

I would never intend to. It's like you said, I would probably gravitate towards certain procedures, just in both, and deal with those more often. I just personally feel more interested in procedures across disciplines rather than just those in one of them. It would be better if I had more ability to select what procedures I'd learn rather than spending extra time learning techniques I may not even want to end up using but, that being said, I can't know what I won't want to use until I experience it or have at least some understanding of it, so I will keep an open mind in med school, but that doesn't change my current preferences.

Your current plan seems really long, tiring, and emotionally exhausting.

I agree. I'd rather I had some alternative that doesn't require me to do something like two surgical residencies apart from one another. It will be hard enough to get into, let alone get through one of them. That being said, I am pretty resilient.

I thought I could handle a grueling specialty and had an interest in neurosurgery and wanted to have the most intense possible career, taking care of patients with life vs death outcomes...

Personally, I am more interested in procedures affecting quality of life than those dealing with life and death. This is probably why I have more of an interest in the peripheral nerve methods for my research interests and probably at least partly explains my leaning towards ortho.

Just after one year did I realize I would love a lifestyle specialty where I could focus time on my other interests (research, music, etc). Interests really do change, and I'm glad I found this out early.

You do raise a good point. I do have other interests (though most of them either surround or are related to my research goals). That being said, this kind of work is much more important to me than that and if I have to sacrifice some or most of the time I would spend on those things then so be it.

There's a reason why s/he is a resident. Keep an open mind when you are young and really try to appreciate the advice that people give you. It's better to explore and learn at an early age.

I couldn't agree more. That's exactly why I'm posting on this forum. I want your opinions. My method of handling advice is that I hear what everyone has to say, then, at the end of the day, I make my own decision.

Also more than anything else, less is more. Why not just focus your energy on one of the specialties and be the best doc/researcher you can be?

I do intend to be the best I can be. I don't necessarily subscribe to the idea that less is more, but I definitely see many times where I do think it does apply. I also do not think those two things are necessarily mutually exclusive.

You have strong interests in research - how are you going to be able to do all the crazy long surgeries and procedures and be a productive academic on the side?

This is the same as the common argument against the existence of MD-PhDs but there are plenty of those people doing procedures and also doing research. That being said, I'm not on this thread to argue about MD-PhDs and that would get us a bit too far off-topic I think.

And remember that the cutting edge stuff is not necessarily what the bread/butter of a specialty is.

Certainly. I would never imagine those procedures to be commonplace, but the knowledge of them will be necessary for me to do what I want to do (if they were, it would probably be a lot easier for me to figure this out, to be honest).


All of the above being said, I want to thank everyone here for engaging in this discussion despite disagreeing with the premise. It has been somewhat helpful to see what many of you have said on this topic. Hopefully, it will eventually get me where I am trying to go.

 

[BarcaBest23]

you also need to think of the time commitment, I get that you want to be the muscle, bone, tendon and nerve - meister along with a touch of CNS, but MD-PhD is roughly 6 years (fastest I've seen), then 5 for ortho, then 6-7 for NSG (assuming you do both which doesn't seem realistics) then another 1 for fellowship (which most academicians do). That is roughly 20 years worth of training/school. That is a LONG road, it might take so long that you might no develop into being exactly what you want as your early career will be really your mid career timeline and your mid career will be retirement. You could do Ortho residency, then 2 fellowship, 1 hand (TMR, nerve work etc) and then spine or Tumor (OI stuff)

 

[PTPuser]

Umm....ortho and NS residency is grueling....

I can't fathom how someone can finish one and take on another.

 

[AZDev]

...you also need to think of the time commitment...roughly 20 years worth of training/school.

This is exactly why I'd rather there was a way to deal with this without doing the residencies in sequence and thereby the reason why I'm asking on here. Repeating again, as I have above, since generally a 2nd residency is unfunded and the difficulty of getting into and through even one such residency will be hard enough, it would be better if there was another way to get this sort of training that didn't require this. In short, I'm pretty well in agreement with all of you that doing one residency and then the other would be generally undesirable simply due to the length of time required and lack of funding for such an endeavor. If I could somehow get the training I want without these issues, that would be significantly more desirable.

You could do Ortho residency, then 2 fellowship, 1 hand (TMR, nerve work etc) and then spine or Tumor (OI stuff)

Tumor is less up my alley, honestly. I'm just not that interested in cancer treatment/research.

 

[Miles Gloriosus]

You could do Ortho residency, then 2 fellowship, 1 hand (TMR, nerve work etc) and then spine....

Don’t think you’ll need second spine fellowship but there’s your answer. Discussion over. Can close thread now.

 

[VincentAdultman]

Lowly M0 but I shadowed an orthopod who was involved with one of these projects through the military (where else can you find a significant population of otherwise very healthy amputees) and it was by no means HSS

That’s fine and doesn’t really contradict what I said.

 

[cybermed2424]

I think it’s also worth noting that you can still be involved in all of these projects research wise without having the complete breadth of surgical skills you mentioned.

 

[AZDev]

I think it’s also worth noting that you can still be involved in all of these projects research wise without having the complete breadth of surgical skills you mentioned.

Arguably, it would be more useful for me to have regular experience treating patients with a given problem if I intend to do research on addressing that problem. That being said, I certainly agree that the lack of training doesn't necessarily preclude me from collaborating with others of such experience or background. Still, I only want to research patient populations I am interested in treating so this may not necessarily solve my issue there, though I'm sure there are ways I could make that work.

 

[libertyyne]

Arguably, it would be more useful for me to have regular experience treating patients with a given problem if I intend to do research on addressing that problem. That being said, I certainly agree that the lack of training doesn't necessarily preclude me from collaborating with others of such experience or background. Still, I only want to research patient populations I am interested in treating so this may not necessarily solve my issue there, though I'm sure there are ways I could make that work.

Go watch some neurosurgical electrode implantations on youtube and figure out if you can live without doing that by just collaborating with someone. Most residents do not find them particularly exciting procedures.
Another question you should be asking is would patients be better off by having different aspects of the procedure performed by people who tend to do this more often. Like even for neurosurgical procedures the surgeons will sometimes involve experts in other fields to own the approach since they are ultimately doing them more often and would have more experience managing the approach compared to the neurosurgeon. Like having ENT for transphenoidal approach or gen surg for anterior approaches for the spine.
Even with training, and someone credentialing you for a procedure doesn't necessarily make you the best person for that procedure.

 

[g3tb0mbed]

Everyone says they are "resilient" and can handle anything prior to medical school. I wouldn't even be thinking about this until you enter medical school (assuming you get accepted) and see how much work this would be. Peoples opinions on what they want to do change VERY quickly in medical school.

 

[DrOrthoSpineMD]

for the love of god, please do NOT consider doing 2 back to back surgical residencies. You will hate yourself. Pick 1 and be great at it.

 

[TelemarketingEnigma]

On a different note than the surgical details (since that is def not my field of interest or expertise), I think it's important to consider how the path of a research career may take you different places than whatever specific thing got you interested in the field. Some of it has to do with luck, some with practicality, some with your own research/clinical/networking abilities.

It's totally good and okay for research interests to evolve as you get more exposure to the field (and other fields). A personal example: one of the things that got me interested in medicine/research is Ebola. I thought it was the most fascinating thing ever and that's what I told everyone I wanted to study, and do some kind of Global Health work. But not everyone who thinks Ebola is interesting will end up working in a BSL-4 lab or on the front lines of an outbreak. That initial interest led me to explore infectious disease/medicine/public health more broadly. The research I do now (and that feels more realistic to me as a long term career path) has nothing to do with Ebola, but I got lucky and took advantage of some cool opportunities I was given, even if I wasn't sure I liked it, then it turned out I liked it and am good at it. If I'd had my heart set on Ebola or nothing I'd probably be unhappy right now (or at least, wouldn't have much productivity under my belt).

In my job before med school, the program directors at the research institute hosted lunch talks for trainees where they basically laid out the whole path their careers took to get them to their current position. Very few of them knew exactly where they were headed the entire time, and there's a huge amount of luck that goes into a successful research career (along with lots of hard work). Being flexible and open to accepting that luck if/when it comes will help you achieve success in whatever field you land in.

 

[AZDev]

On a different note than the surgical details (since that is def not my field of interest or expertise), I think it's important to consider how the path of a research career may take you different places than whatever specific thing got you interested in the field. Some of it has to do with luck, some with practicality, some with your own research/clinical/networking abilities.

It's totally good and okay for research interests to evolve as you get more exposure to the field (and other fields). A personal example: one of the things that got me interested in medicine/research is Ebola. I thought it was the most fascinating thing ever and that's what I told everyone I wanted to study, and do some kind of Global Health work. But not everyone who thinks Ebola is interesting will end up working in a BSL-4 lab or on the front lines of an outbreak. That initial interest led me to explore infectious disease/medicine/public health more broadly. The research I do now (and that feels more realistic to me as a long term career path) has nothing to do with Ebola, but I got lucky and took advantage of some cool opportunities I was given, even if I wasn't sure I liked it, then it turned out I liked it and am good at it. If I'd had my heart set on Ebola or nothing I'd probably be unhappy right now (or at least, wouldn't have much productivity under my belt).

Very cool story, Enigma. I also have some other research interests beyond this topic; that being said, I have the opposite situation to yours. I will probably not be happy unless I at least give my best effort to trying to achieve my goal.

In my job before med school, the program directors at the research institute hosted lunch talks for trainees where they basically laid out the whole path their careers took to get them to their current position. Very few of them knew exactly where they were headed the entire time, and there's a huge amount of luck that goes into a successful research career (along with lots of hard work). Being flexible and open to accepting that luck if/when it comes will help you achieve success in whatever field you land in.

You're definitely right about that. Much of my previous research came about accidentally or as a matter of coincidence, being in the right place at the right time or the wrong place at the right time. My more recent projects, on the other hand, were almost entirely formed from me planning out my opportunities and resources to give myself the best chance to succeed at the thing I wanted to do. I may not always be able to get to exactly what I want, but there are usually roundabout ways of getting to where I want to go, one way or another. You're definitely right about openness to opportunity, but moreso than that, we need to not just accept opportunities that come up but seize the day when it comes. Unlike carpe diem's typical implication, however, I believe many of those opportunities come about not in spite or ignorance of plans but because of them (even if it wasn't intended).

I know of game design majors who started wanted to be a game designer and thought they'd love to work for a major company, but later found a deep passion for science and found a way to combine those two goals by working on games for change and simulation games. The key isn't to give no thought to the future. The key is to plan but be prepared to seize the opportunities that bring you closer to where you want to be, even if you at first don't realize what that is.

 

[TelemarketingEnigma]

Very cool story, Enigma. I also have some other research interests beyond this topic; that being said, I have the opposite situation to yours. I will probably not be happy unless I at least give my best effort to trying to achieve my goal.

The point isn't that you shouldn't try - the lucky opportunities don't just fall into your lap, you do need to work to put yourself in a place for them to happen. You should continue to towards your very specific goal. HOWEVER, the point is to be practical and consider, as you progress forwards, if any of those opportunities might take you in a different, more practical direction that would still be interesting and satisfying to you. You've gotten a lot of feedback here about the practicality of double surgical subspecialty residencies (slim to none) - if you fail to get into those residencies, or go that route and fall short/burn out, will you still be happier than you would be if you'd opted to take a traditional single residency, and crafted a career that may be different from your original goal but still successful by other metrics? It worries me to see such staunch, inflexible commitment to something very few people in the world will do.

You also really should look into the teamwork aspect of the things you're interested in - as others have mentioned, surgeons often collaborate with other surgeons/specialists on these incredibly complex cases. There are huge teams of people involved in these research projects and clinical efforts. You don't need to be able to do every single part of it yourself.

 

[AZDev]

It worries me to see such staunch, inflexible commitment to something very few people in the world will do.

It is hard to be committed to a specific solution until I know where I stand and what all of my options are, but at this point, I can't say where I will be. That being said, there is a reason I suggested the following:
- That I lean ortho
- That a hand and PNS fellowship are likely to at least half address part of my interests

It isn't like I've stated for sure that I'm going to be able to do any of these things anyway. This is all hypothetical. It's about figuring out my options. I really don't think I'm disagreeing that much with most of you regarding the difficulty of the pursuit nor the stress or limitations I would face, or even that I have options that involve not doing that. I've repeated this numerous times and I'm pretty tired of restating an agreement with a premise that several of you seem to think I am disagreeing with.

I really would rather we stop debating what I should or shouldn't do as I came to this thread for advice on the topic of the thread but I feel like we've spent a lot of time on a topic not directly relevant to the topic in question.

You don't need to be able to do every single part of it yourself.

Agreed. I don't feel the need to debate that aspect further as I never questioned that this would be 100% necessary no matter which of the routes we discussed above I took.

 

[esob]

Here is my one and only in-thread warning to consider your responses in a thoughtful and considerate manner. If you feel the need to give someone a reality check, do so in a manner that is consistent with our TOS. The lounge should be the forum of choice if you absolutely feel the need to be a toxic member; it is no longer acceptable to do it in the medical student forum.

 

[DarkHorizon]

It is hard to be committed to a specific solution until I know where I stand and what all of my options are, but at this point, I can't say where I will be. That being said, there is a reason I suggested the following:
- That I lean ortho
- That a hand and PNS fellowship are likely to at least half address part of my interests

It isn't like I've stated for sure that I'm going to be able to do any of these things anyway. This is all hypothetical. It's about figuring out my options. I really don't think I'm disagreeing that much with most of you regarding the difficulty of the pursuit nor the stress or limitations I would face, or even that I have options that involve not doing that. I've repeated this numerous times and I'm pretty tired of restating an agreement with a premise that several of you seem to think I am disagreeing with.

I really would rather we stop debating what I should or shouldn't do as I came to this thread for advice on the topic of the thread but I feel like we've spent a lot of time on a topic not directly relevant to the topic in question.


Agreed. I don't feel the need to debate that aspect further as I never questioned that this would be 100% necessary no matter which of the routes we discussed above I took.

To answer your original question, with your full license, you can do whatever you want, as long you have privileges to do it in the hospital. The procedures you have listed here are highly specialized and are only done by handful of individuals in the country. There are only a handful of places on the country that even have resources to support such endeavours. It really doesn’t matter whether you do ortho or NS, you’ll need to hook up with one of these institutions and then rise through the ranks. It’s such a niche practice that there is almost no way to survive just doing these procedures unless you are at a large tertiary center getting just these types of referrals and have a lab associated with it. No one can tell you the blueprint to this route. There are few surgeons involved in this, and it is usually a team thst includes both NS and ortho. Just do the residency that you want to do and try to be at a large academic center who’ll support your research interests.

 

[AZDev]

To answer your original question, with your full license, you can do whatever you want, as long you have privileges to do it in the hospital. The procedures you have listed here are highly specialized and are only done by handful of individuals in the country. There are only a handful of places on the country that even have resources to support such endeavours. It really doesn’t matter whether you do ortho or NS, you’ll need to hook up with one of these institutions and then rise through the ranks. It’s such a niche practice that there is almost no way to survive just doing these procedures unless you are at a large tertiary center getting just these types of referrals and have a lab associated with it. No one can tell you the blueprint to this route. There are few surgeons involved in this, and it is usually a team that includes both NS and ortho. Just do the residency that you want to do and try to be at a large academic center who’ll support your research interests.

This was sort of how I felt like it was likely to be given how niche the topic is. TMR in particular, I think, will be one of the more difficult things I could learn in the sense that I don't know of any formal programs that teach it nor does it seem particularly common. I believe someone pointed out above that there was a program that did do osseointegration though, so maybe I have some more hope in learning that procedure at least. To my knowledge, osseointegration, as a procedure, seems to be a more familiar topic than TMR, but I could be wrong.

I definitely agree regarding the survival aspect. I at least know that I find the more typical orthopedic surgeries interesting enough that I'd spend whole days watching surgeons perform procedures in the outpatient center where I shadowed. I would be very surprised if I lost interest in doing those sorts of procedures. That being said, I only really observed hand / upper extremity procedures distal from the shoulder in that experience. I would really like to broaden my understanding of the scope of orthopedic surgery in general though I find it far less interesting than the neurological aspects (in particular, neurological surgeries involving implanted technologies not only in the brain, but in the spine, in the peripheral nerves, and so on). Having been to several events and networked with a lot of neuromodulation specialists, I definitely find electronic medicine fascinating and incredibly useful and would love to find a way to work that into my practice as I think it has great potential not just for its more common applications in chronic pain, but also for its applications to other problems.

I feel the need to explore neurological surgery more though to really get a sense of what, beyond peripheral nerve and spine surgery and neuromodulation, interests me, in neuro, that is more commonplace. The physiology of the brain and nerves is far more fascinating to me than the behavior of muscles and bones, but I definitely think the above is at least part of the reason why I lean ortho, but until I see more neuro procedures, talk to more neurosurgeons, and learn more about the breadth of neurosurgical procedures beyond those I am already familiar with (research wise and from reading up on the topic on residency pages and talking to / shadowing specialists in that area) I cannot say for certain what my final path will wind up being. Maybe I will change my mind and I will lean more towards neuro, but right now, I think I lean somewhat ortho (at least until I can get a larger sense of how I could live my life as a neurosurgeon since life as an orthopedic surgeon is what I am more familiar with at the moment). [I'm going to do some more research on SDN to see what I can find on the topic]

Thanks again!

 

[AZDev]

Go watch some neurosurgical electrode implantations on youtube and figure out if you can live without doing that by just collaborating with someone. Most residents do not find them particularly exciting procedures.

I haven't had much luck finding these for humans (though there are a lot of deep brain stimulation (DBS) procedures I was able to watch), but I have seen some jove videos of animal implantation procedures like this and I thought they were one of the coolest things I've ever seen. Also, sorry it took me so long to reply to this one as I wanted to find one of the links in case anyone was curious about it; it took me a while to get my login information since it's been a little while since I used jove and my access is limited now (I was only able to watch some of them because I was on a free trial T_T).
- rodent animal model: Surgical Implantation of Chronic Neural Electrodes for Recording Single Unit Activity and Electrocorticographic Signals | Protocol