If you had to do first year of neuro again what would you do differently

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Hoping our fellow seniors can help us incoming first year neuro residents.


1.) IF YOU WERE TO DO FIRST YEAR OF NEUROLOGY AGAIN WHAT WOULD YOU DO DIFFERENTLY?

2.) WHAT DO YOU WISH YOU WOULD OF KNOWN/BEEN TOLD PRIOR TO STARTING FIRST YEAR OF NEUROLOGY?

 

[llogg]

I have to take it back even to internship.
1. I would skip every conference of my intern year and study neurology during this time. I would spend every bit of reading time during internship reading neurology. My knowledge of heart failure management is almost useless to me now.
2. There's not much I would change about PGY2 year, mainly because there's not much I COULD change. You just have to get through it. I guess the one thing I'd alter would be my mindset. Expecting it to be easier in some respects than internship only to find it much much more difficult was hard to take.
3. I wish I had been told, way back in med-school, the proper way to think about doing an exam, particularly the neuro exam. Don't ever think "I'm testing extraocular movements now." Instead think "I'm testing cranial nerves III, IV, and VI, as well as gross observation of the function of CN VIII (can they hear me) and cognition (can the understand the instruction)." I try to teach this way to all the medical students I come across. If every exam I had done since medical school had been done this way I'd have no trouble remembering dermatomes and peripheral nerve distributions by now.

 

[Amos]

I have to take it back even to internship.
1. I would skip every conference of my intern year and study neurology during this time. I would spend every bit of reading time during internship reading neurology. My knowledge of heart failure management is almost useless to me now.
2. There's not much I would change about PGY2 year, mainly because there's not much I COULD change. You just have to get through it. I guess the one thing I'd alter would be my mindset. Expecting it to be easier in some respects than internship only to find it much much more difficult was hard to take.
3. I wish I had been told, way back in med-school, the proper way to think about doing an exam, particularly the neuro exam. Don't ever think "I'm testing extraocular movements now." Instead think "I'm testing cranial nerves III, IV, and VI, as well as gross observation of the function of CN VIII (can they hear me) and cognition (can the understand the instruction)." I try to teach this way to all the medical students I come across. If every exam I had done since medical school had been done this way I'd have no trouble remembering dermatomes and peripheral nerve distributions by now.

Interesting.

Anyone else feel the same way about just focusing on neuro as much as possible during the intern year?

I've heard some say that you should focus on being the best internist you can for 12 months since that is the last time you will get some of that stuff.

I know I won't have much free time, but I do want to try and be productive in terms of what I focus on in terms of reading.

 

[typhoonegator]

It depends on what you want to do, and what you neuro residency will be like. If you want to be a neurointensivist, you'd better learn some medicine, actually, you'd better learn a ton of it. If your neurology residency has roughly 50-60 inpatients with every comorbidity known to man, you'd better learn some medicine at least so you can survive residency, because you aren't getting medicine consults on all of them, and they WILL go into AF with RVR if they smell fear.

If your residency is clinic/consult driven, or you are mostly interested in a specialty with less need for a broad internal medicine background, then you can probably focus on neuro during internship without losing out on much.

Please note, however, that if you've read many of my posts, you know I am a strong proponent of a broad knowledge of internal medicine and would never personally advocate for short-changing your medical education during internship. Not everyone agrees with this viewpoint. But remember, you are going to be a neurologist for your whole life, and there is a reason why until recently, neurology was a medical subspecialty.

 

[HarveyCushing]

It depends on what you want to do, and what you neuro residency will be like. If you want to be a neurointensivist, you'd better learn some medicine, actually, you'd better learn a ton of it. If your neurology residency has roughly 50-60 inpatients with every comorbidity known to man, you'd better learn some medicine at least so you can survive residency, because you aren't getting medicine consults on all of them, and they WILL go into AF with RVR if they smell fear.

If your residency is clinic/consult driven, or you are mostly interested in a specialty with less need for a broad internal medicine background, then you can probably focus on neuro during internship without losing out on much.

Please note, however, that if you've read many of my posts, you know I am a strong proponent of a broad knowledge of internal medicine and would never personally advocate for short-changing your medical education during internship. Not everyone agrees with this viewpoint. But remember, you are going to be a neurologist for your whole life, and there is a reason why until recently, neurology was a medical subspecialty.

Typhoonegator thanks for your post. I have heard several other residents mention the same viewpoint as you, along with several attendings I have spoken too. They have all told me how important it is to have a strong foundation in medicine and to learn as much during internship. I might have an interest in being a neurointensivist, and one of the attendings told me it would be worth while to double board in medicine and neurology. He might be a little biased since he is double boarded in those himself, however I don't see how added medicine knowledge could hurt one's training. If anything it would help strengthen the clinician imho.

 

[llogg]

Just to clarify, I don't think you should actively "short-change" your medicine education, but if you're in a high-volume program you'll learn plenty without doing what I did, which was spend free-time reading on cardiomyopathy and Crohn's disease and a host of other issues that don't really serve me well now. You need to learn the basics. You need to learn them so well that they come automatically. But I don't think you need anything beyond that.

 

[Fencer]

If you read (and retain) the volume I of Bradley prior to start Neurology residency, you will be a star. The first 400 pages are the approach to the Neurological patient as we do the exam. That gives you a clue to learning while examining all of those patients you see during the PGY2.

The other book to "understand" is Brazis' localization. After all, the first thing that we do is localize the lesion. Reading green journal or other articles is a waste of time during PGY2. (unless you are keeping your lab research active).

 

[bustbones26]

Hoping our fellow seniors can help us incoming first year neuro residents.


1.) IF YOU WERE TO DO FIRST YEAR OF NEUROLOGY AGAIN WHAT WOULD YOU DO DIFFERENTLY?

2.) WHAT DO YOU WISH YOU WOULD OF KNOWN/BEEN TOLD PRIOR TO STARTING FIRST YEAR OF NEUROLOGY?

1) Quit residency after the internship year
2) Something, anything that might have been useful!

Okay, let me put the kidding aside here and get serious. In my first year of residency, I really wish my program would have told me that they placed so much emphasis on RITE scores! Believe me I always asked how to prepare but had no advice or guidance from my peers or attendings. I just had to learn on my own and feel that I learned too late. I did have on attending that provided me with the huge RITE manual back from whenever she took the RITE exam years earlier and stated, "hey, they repeat stuff, just look this over". Unfortunately, she did this two weeks before the actual RITE? I wish they would have told me that they had seven copies of prior RITE manuals floating around somewhere prior to that?

I wish I would have had better reading resources because neurology textbooks suck! I learned on my own of some great books, if you need to know my recs on what to read, search my old post or PM me.

 

[Neurologee]

I had a pretty intense Intern year, during which time I did not focus on Neurology whatsoever (except that folks kept throwing the Neuro cases my way because they knew I was interested). I do not regret that decision at all. I learned an enormous amount of info that is applicable everyday to my Neuro patients. Our inpatient Neuro patients can sometimes boil down to being just really complicated medicine patients with some Neuro (i.e., CHF, DM, CAD, and now had a stroke on top of it), and I am constantly relying on my experiences from intern year to best manage the whole patient.
Additionally, I completely agree with Typhoonegator - patients can some how sniff out inexperience/lack of confidence in internal medicine skills, and they WILL get complications when you are on call in the middle of the night 😉 Best to know the treatments like the back of your hand, because it always happens when you are busy and really sleepy.