Dual residency: Med/neuro?

[tranzformer]

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Is there any advantage with doing a Med/Neuro residency? I am thinking about doing a critical care fellowship in the future and it seems like the added knowledge from internal medicine would be very useful. However I'm not sure the extra year is worth it since most of the things I would need to know I would learn in my fellowship. However in the scheme of things, one year doesn't seem like much in regards to college, med-school, residency...etc. I just wonder if my neurology training would suffer since I most likely wouldn't have any free time for electives, and with the 80hr rule I wonder if I would be competent in the two specialties at the end of the 5yrs? I know I am rambling on, but these are a few thoughts I have been having recently. Any thoughts.

 

[Fencer]

I trained at Duke over 10 years ago. As a chief resident, I had two junior residents who were doing the dual residency in IM/Neuro - 5 years with limited electives. Both of the guys ended up being Neurointensivists at academic medical centers (Columbia and Wisconsin). They were clearly more comfortable managing vents and other thing at the NICU.

It certainly makes sense if you are committed to get into that type of specialty (Neuro ICU).

 

[tranzformer]

I trained at Duke over 10 years ago. As a chief resident, I had two junior residents who were doing the dual residency in IM/Neuro - 5 years with limited electives. Both of the guys ended up being Neurointensivists at academic medical centers (Columbia and Wisconsin). They were clearly more comfortable managing vents and other thing at the NICU.

It certainly makes sense if you are committed to get into that type of specialty (Neuro ICU).

Thanks for the comment. At this point I am interested in neuro critical care. I am sure that during residency I will better understand if that is something that I would want to do a fellowship in. I guess at this point I am thinking about the usefulness of doing an extra year. While it wouldn't hurt to spend an extra year in training, I wonder if the benefits outweigh the disadvantage? Ultimately I want to be a great clinical neurologist first. The IM would just be a nice addition to the training. The thing that concerns me is that the few dual IM/neuro programs are at weaker neuro institutions. While I know the neuro training would be adequate, I still don't want to sacrifice my neuro training as a result.

 

[typhoonegator]

This is an interesting question. I personally think that if you want to become a neurologist, then you should train at a program that you feel would best prepare you for that specialty...it wouldn't make sense to compromise your training to go somewhere with a combined program just to say you got dual training.

I am a PGY-4 in Boston, and I'm going into neurocritical care, and I don't know anyone in the last few years who has come through our fellowship program with a combined neuro/IM residency. The purpose of a good NCC fellowship is to prepare you for handling all the issues that come up in a neuroICU, and I don't think an extra year of IM residency would give you that much of a leg-up. I certainly don't think anyone could tell you apart from a standard-trained fellow at the end of NCC fellowship. Now, anesthesiology is a different story, and people who train in anesthesia before making the jump to neurocritical care bring a different mind-set and philosophy to the ICU, which I feel can be very valuable.

Personally, I would think that the fields of neurorheumatology, neuroID, and neurocardiology would benefit the most from someone with dual background, since these are the specialties that rely so heavily on the classical disciplines of internal medicine. But then again, you don't find very many of these specialists around outside of major academic centers.

 

[donesoon]

Now, anesthesiology is a different story, and people who train in anesthesia before making the jump to neurocritical care bring a different mind-set and philosophy to the ICU, which I feel can be very valuable.

Interesting... count me as another MS4 interested in neurocritical care. Not to completely threadjump, but do you have any thoughts on what each of the primary specialties (neuro, nsurg, anesth, IM, EM) bring to the table as neurointensivists? Or opinion as to which primary specialty would best prepare a person for NCC?

 

[Fencer]

This is an interesting question. I personally think that if you want to become a neurologist, then you should train at a program that you feel would best prepare you for that specialty...it wouldn't make sense to compromise your training to go somewhere with a combined program just to say you got dual training.

There are some (but not many) dual IM/Neuro programs. I wouldn't call Duke IM or Neurology training a choice that "compromise your training". However, some of the other IM/Neuro residencies are second tier.

The truth is that there is very little difference among the top 20 neurology residencies. A bright Neurology Resident will be bright even in a second tier program. Although you are aiming for top possible training, as long as you have exposure to a variety of patient populations and you have time to study textbooks and articles, you will develop just fine. Indicating otherwise, is just plainly snoobery! As a NINDS Reviewer, I seen terrible first tier applicants (not that often, I concede) and but quite a few outstanding second and third tier applicants.

Twenty years from now, you might be known for either providing outstanding care to a local community (we need many great doctors of this type) or if at an academic center, by what you have published. If the latter, then it won't matter whether you have 1, 2, 3 or more board certifications but what is the quality and number (the dean doesn't know neurology but knows how to count) of your publications

 

[tranzformer]

There are some (but not many) dual IM/Neuro programs. I wouldn't call Duke IM or Neurology training a choice that "compromise your training". However, some of the other IM/Neuro residencies are second tier.

Does Duke still have the IM/neuro residency? I looked on Freida on the only places listed are:

Indiana
Tulane
Buffalo
SUNY-SB
WVU
MCW

Are there more dual programs that Freida just hasn't listed?