In neurology residency do you learn more basic neuroscience, or just how to manage neuro disease?

[chajjohnson]

This might seem like a strange question, but I got into science and medicine specifically because I love learning about the brain and how it works (especially the neuropsychological and consciousness aspects). I'm pretty sure I want to go into neurology at this point (I'm finishing up MS2) mostly because it is the field I find most intellectually stimulating, but I also find many of the diseases interesting and like the practice options. However, I'm wondering if a career in neurology will actually require further understanding of basic neuroscience or if residency and beyond mostly focuses on the minutiae of differential diagnosis and patient management. Just to give an example, the other day I got distracted from studying by looking up the current theories and papers on the mechanisms of synaesthesia and LSD hallucinations. That's the kind of stuff I really love learning about, but I had a feeling the whole time that because this was so basic and not related to a disease it probably wouldn't be a part of a neurologist's job.

I'm not saying I don't want to be a physician, I do, but it would be great if I could learn something about the brain besides being focused on disease and medicine. One thing I am thinking is going into either behavioral neurology or neuropsych fellowships to focus more on the neurological problems I find most intellectually stimulating, but I can see the same problem of solely focusing on disease and patient care appearing in those fields as well.

I guess basically my question is will learning more fundamental things about the brain and how it works to create our conscious life be a part of my medical career, or will it have to be more of a hobby in my off time? I'd love to hear any feedback from those more experienced than I about these questions.

Edit to clarify: I'm not saying I want to do research or anything like that. To put it simply, is our first year neuroscience class the most in depth a neurologist looks into how the brain works?

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[typhoonegator]

Neurology is the practical application of neuroscience to humans. The whole point of the field is to prevent, diagnose, and manage neurological dysfunction, disorder, and disease. This often requires a strong working knowledge of basic and advanced neuroscience, particularly within subfields of the profession, but the goal is to use this knowledge to improve the lives of our patients.

An engineer can love physics, but ultimately the physics that he uses everyday is the physics that facilitates his job as an engineer. Synaesthesia is cool and all, and maybe further study of it will lead to new insight into the care of patients with more common disorders, but there are only so many hours in the day and you're unlikely to have a synaesthesia clinic. You say you see a "problem of solely focusing on disease and patient care", but it turns out that your patients will expect and fully deserve such a focus. Patient care is the motivator that drives a great deal of neuroscience research.

Now if you're interested in research then you can focus your research on more foundational biology and neuroscientific exploration within a chosen subfield, but in medicine the ultimate goal is always to use those discoveries to improve care. You're going to have a hard time getting the NIH to fund a study on color theory and its electrographic correlates.

Once you're in residency I think you'll find that even among mundane diagnoses, the variation in presentation between cases and the different responses to therapy is very intellectually stimulating, and reveals the nuance of the underlying pathobiology.

 

[Thama]

Practically speaking your first 2 years will be 100 percent clinically focused. After that depending on the program you might have the chance to start some basic science research if that's what you want as a career.

Even if you are a PhD with a 100 percent basic science focus, you won't get funding unless you can show how it might be useful for the organisms supplying said funding, namely, humans.

 

[Kazaki]

OP, I'm in the exact situation you're in!

http://www.nobelprize.org/nobel_prizes/medicine/laureates/2014/

So neurologists can't do the type of research that these guys are involved in? What if they do a PhD in neuroscience? The Human Connectome Project was done at WashU, University of Minnesota, Oxford, MGH/Harvard, and UCLA. You reckon neurologists were involved in the project or was it completely run by neuroscientists?
It's just that this type of basic research is so interesting and the practical applications can be endless!

 

[typhoonegator]

To be clear, understanding neuronal migration and the Human Connectome Project have direct and important implications to the future of clinical medicine. They aren't esoteric minutia. They are also something that you need to devote an entire career to, largely at the expense spending time as a clinical neurologist. That doesn't mean there aren't MDs involved in these sorts of research endeavors, but it is a clear departure from what you were trained to do in medical school and residency. You have to seek it out.

There is a gulf of difference between taking a deliberate track towards a basic science career focused on human genomic research, or neuronal progenitor cell development, or research-based neuroimaging tools, and thinking that synaesthesia is really cool. As an MD, you can be a very devoted neuroscience enthusiast in your off hours. But if you want to make meaningful contributions to neuroscientific discourse, you need to start looking around at what you're willing to give up to do that. Interested in consciousness? Then do a research fellowship with someone who studies resting state networks. Devote years of your life to it, and you might get a K08. Do well there, and you might get an R01. Get a couple more of those, and you might be able to support a livable salary. You will make less than your residency colleagues, and probably a lot less. And work more. And you'll have to shutter your lab if the funding dries up.

Full disclosure: I am an MD who does > 80% publicly-funded research. It took years of extra training to establish myself in my field. Liking the subject matter isn't enough; it's a siege. Attrition is high, the sacrifices are obvious, and the successes are largely private, or at least insular. I love what I do, as do my colleagues (usually), but having conviction that what I'm doing is important and satisfying is very different from enjoying reading about a particular topic. You can do anything you want to do, but at least go in with your eyes open so at least you understand the tradeoffs.

God I sound old.

 

[chajjohnson]

Typhoonegator,

I am not interested in having a career in research. In fact, I was accepted to an MD/PhD program and I decided to only do the MD program at my school. In terms of my career and day-to-day life I do not want all the hassle and uncertainty of a career in research. However, I love to LEARN about neuroscience. I am fine not actively contributing to new knowledge, I just like learning about what other people are figuring out.

All that being said, let's say the human connectome project somehow finds a way to be used in clinical medicine. Will all neurologists then need to read up on the basic science of it to understand how it's used in clinic? With that example in mind, is there is a steady stream of similar advancements in the field that require neurologists to read some basic science background on the topic to understand how it works? I can imagine a field like neuropsych or behavioral neurology where there is lots of new research coming out would require clinicians to be pretty up to date on the basic science of the field, similar to oncology. Or, maybe I am mistaken and a neuropsych clinician would never need to open the pages of whatever basic science journal is dominant in that field.

 

[typhoonegator]

In order for tools to become clinically useful, they need to be sufficiently simple and tested in such a way that you need very little background information to use them safely and appropriately. You don't need to know the history of family based studies and GWAS that led to the discovery of PCSK9 inhibitory variants that are associated with decreased serum LDL. Nor do you need to know about the shotgun library approach to compound identification that led to prioritization of PCSK9 inhibitors for Phase 0 trials. Nor do you need to read the Phase 2a, 2b, or 3 trial results, or the FDA approval letter. All you need to do is read last months consensus guideline in the American Journal of Cardiology about when to prescribe them in the clinic.

If you're a vascular medicine physician, then you might take it upon yourself to know everything about them, and it might serve you in your clinic. But most people don't. Similarly, yes, if you want to be an up-to-date behavioral neurologist, then you want to skim a few journals every month to see what's happening in your subfield at the basic science level. But the pace of scientific progress is slow enough that your career will be over before many of the lines of basic and translational research will have direct bedside implications. Oncology is about as different from behavioral neurology as you can get, with respect to the pace of advancement right now and the development of precision therapeutics.

 

[DocMom1]

In order for tools to become clinically useful, they need to be sufficiently simple and tested in such a way that you need very little background information to use them safely and appropriately. You don't need to know the history of family based studies and GWAS that led to the discovery of PCSK9 inhibitory variants that are associated with decreased serum LDL. Nor do you need to know about the shotgun library approach to compound identification that led to prioritization of PCSK9 inhibitors for Phase 0 trials. Nor do you need to read the Phase 2a, 2b, or 3 trial results, or the FDA approval letter. All you need to do is read last months consensus guideline in the American Journal of Cardiology about when to prescribe them in the clinic.

If you're a vascular medicine physician, then you might take it upon yourself to know everything about them, and it might serve you in your clinic. But most people don't. Similarly, yes, if you want to be an up-to-date behavioral neurologist, then you want to skim a few journals every month to see what's happening in your subfield at the basic science level. But the pace of scientific progress is slow enough that your career will be over before many of the lines of basic and translational research will have direct bedside implications. Oncology is about as different from behavioral neurology as you can get, with respect to the pace of advancement right now and the development of precision therapeutics.

Agreed.

OP: It sounds like a career in neurosurgery might be more in line with your interests.

Because neurosurgeons' work tends to be much more procedural and interventional, the necessity and efficiency of "bench-to-bedside" discoveries is more palpable in terms of technique-based research, diagnostic research, and neuroscience research. As a mostly diagnostic specialty, the impetus for neurologists (unless you're in NIR) to adopt and integrate new neuroscience knowledge is low, as most diagnoses can be made by recognizing clusters of symptoms, in some cases with the help of imaging or electrophysiology.

Although staying updated on basic neuroscience research can help neurologists better understand the molecular/neuroscientific basis of the diseases they diagnose, it does not significantly influence practice. By analogy, you can be an outstanding baker without understanding the chemical physics of heat transport and Runge-Kutta thermodynamics. And knowledge of the latter does not a better baker make.

 

[deathmerchant]

That being said, a lot of people come into the field because they are curious about the brain, including myself. As mentioned above, its very difficult to do everything from unchartered basic neuroscience research to being good and efficient clinically. But I feel the best way to understand the brain is from the outside, i.e clinically. Brain is not just a complex machine, like for example the heart. It has many 'layers' to it. Even if in future we have all the anatomical/physiological details about the brain we wont be able to understand its function completely. I personally take out a good amount of time to read about the functioning of the brain and things that are not clinically that much relevant- u'll be surprised how little physicians know about things that are not clinically relevant. I enjoy reading them and share interesting articles with people; knowing that most of it wont be much helpful clinically.. May be U will find something interesting to translate from basic science to research!!

 

[QueryNeurology]

Just curious, did you decide on anything? I'm in a similar boat.

 

[Neuro244]

I haven't yet started medical school, but am planning to apply this June/July, as I am currently studying for the brutal MCAT. My interests are a bit similar to the OP, but a bit different. My deep interests and passions lie in learning about neuroscience (i.e. neuroanatomy, neurotransmitters), but more specifically, how neuroscience connects back to consciousness. I would absolutely love to have my efforts focused towards studying neuroscience as it relates to consciousness and altered states of consciousness (i.e. meditation, states of sleep-if you consider these altered states, drugs such as marijuana, LSD, stimulants). In addition, I do also love learning about sleep disorders, but not the most common ones you would see as a sleep medicine doctor such as sleep apnea, and insomnia. I like more of the exotic types such as narcolepsy, somnambulism, sleep talking, sleep paralysis, and how these would have a neuroscience correlate. I've also always had an interest in the more "taboo" or "non-mainstream/socially accepted" subjects such as parapsychology (Out of body experiences, Near Death experiences, lucid dreaming, astral projection) and how these once again can be related/traced back to neuroscience. For instance, Dr.Rick Strassman (MD), wrote a fascinating book called "DMT-The spirit molecule", which looked at how the drug DMT affects people and what they experienced. Essentially he looked at how it related back to the brain, and what people's experiences were (looked at pineal gland in relation to secretion of DMT, along with many other things I'm not mentioning). Moreover, my interests would be in how we can link neuroscience to metaphysical phenomenon as I mentioned above, such as out of body experiences. How can the brain be used and or/studied as an intermediate or tool between this world and spiritual/metaphysical experiences. I did some research as an undergrad but never in a neuroscience setting so I'm not sure exactly what it would be like if I do in fact choose to pursue a Ph.D in neuroscience. I know that the stability, certainty, and salary of a Ph.D differ substantially from an MD and that's what scares me. I'm concerned that if I do in fact pursue neurology since I have a passion for the brain, I might not find the work as satisfying intellectually or rather personally to keep me interested. As you mentioned you could research it on the side on your own, but it's not the same as being very involved in the space. You would be more inclined to diagnosing as doing long assessments of patients to treat more bread and butter cases such as dementia, Alzheimer's disease, stroke, epilepsy, MS, Parkinson's disease, and headaches/migraines.

Moreover, I have done volunteer work for 3 years or so at UCLA Santa Monica medical center/Ronald Regan medical center/Kaiser/and at a hospice (worked with mostly Alzheimer's and dementia patients) and found the experience of talking with patients to be interesting. I mean I don't love working/treating patients, but I don't hate it either. I'm in the middle, and I don't know if that would be enough to keep me going through med school considering my passionate interests. I'm worried about if med school will be something that I will stick with or say half way screw it I don't want to do this. I'm an extrovert for the most part and do connect with people and like making them feel good and smile, but I don't know if diagnosing and treating diseases is something I'd be passionate about. Nowadays in our society (I live in California) I hardly find anybody who's "passionate" about what they do, and I think it's a cliche at this point. At the same time, however, the job prospects for Ph.D's who want to get a tenure-track or remain as a basic science researcher are quite daunting. I'm debating whether to pursue an MD route or a Ph.D route, but am not sure at the current moment as I am really trying to pinpoint what exactly my passion about neuroscience is. I think the above description gives a great overall idea, however. I'm wondering if an MD-Ph.D would be better route such that if the research doesn't pan out (not enough funding since my interests aren't exactly mainstream or clinically applicable/socially acceptable), I would have the M.D. to fall back on. As I said I like working with people and socializing with them but don't know if I would really be as passionate with it as I am more interested in learning about neuroscience.

There may have been some things left out that would give you guys a bigger picture of where I'm coming from, but at this moment in time I'd really appreciate some feedback as to help guide me in the right direction. Feel free to ask me questions that might make it easier for you to help me. Thank you very much!

 

[Alfawave]

It depends upon your approach.neurology residency is about managing neurological disease and patient care. The things you are approaching is an aspect of neuroscience. You can do the PHD in neuroscience after neuro residency or work as an neurologist and entertain your neuroscience thoughts as a hobby. May be in later life, you can open your own lab, fund your own project and work on your ideas.