"Tough" vs. "Cush" Prelim

[Cephalorectus]

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Any thoughts on what constitutes the ideal prelim year for neuro residency? I've heard some pretty conflicting thoughts on the matter:

1. "Tough" prelim - Try to get the strongest foundation in medicine possible. Future neurologists use more medicine than our counterparts going into rads/ophtho/derm...

vs.

2. "Cush" prelim - Learn enough medicine to pass Step3. Spend your free time reading neuro, prepping for PGY-2 year.

 

[GopherBrain]

I chose option "A". It was painful, but I am glad I did it. Why "prep" for PGY2? You have the rest of your life to learn neuro.

 

[Methyldopa]

There are advantages to both options. Getting a solid foundation in medicine is important (with the caveat that medicine is an ever evolving field in that what you learned as an intern may some years from now become a complete fallacy). Also you start seeing the same chief complaints over and over (SOB, CP, Cough, etc), and you just go into an automatic mode where everything becomes just protocol driven. It's important to know about medical diseases, sometimes it applies to neurology. But how much you need to know I think is debatable.

The advantages of cush, as you state, is that you get some time to read about medicine (or occasionaly neuro) and get to have a life outside of residency.

The question is: Is a neurologist that went through a tough prelim a better neurologist than one who didn't?

My guess is no.

 

[Cephalorectus]

Thanks for the input, guys... I guess there's no need to go kill myself for a year in IM.

 

[Onco]

The question is: Is a neurologist that went through a tough prelim a better neurologist than one who didn't?

NO😴

 

[GopherBrain]

The question is: Is a neurologist that went through a tough prelim a better neurologist than one who didn't?

I would think more about whether an R2 that went through a tough prelim a better R2 than one who didn't.

 

[Unsure Person]

The question is: Is a neurologist that went through a tough prelim a better neurologist than one who didn't?

From my experience, some of the best neurologists have a very strong foundation in basic internal medicine. I know a handful of people who are double-boarded in internal medicine and neurology, and I can tell you that they are awesome neurologists. But their specialties also are more relevant for internal medicine, e.g neurocritical care / stroke, neuro-oncology which is very medicine based vs movement disorders or dementia that may be slightly less medicine based. The bottom line is that a strong prelim year in medicine will in no way hurt you, and may help significantly if you choose a subspecialty that is more closely linked towards medicine. Also, remember that 2-3 decades ago, neurology was a subspecialty of internal medicine. Logically so, just as many subspecialties of internal medicine require a good analysis of various aspects of the whole body, so does neurology. Perhaps in some of the subfields, it may not make a huge difference. But if you want a broad generalization, I would definitely say that the neurologist with a strong foundation in internal medicine is a better overall neurologist than one who does not have a strong foundation in internal medicine.

I definitely would not listen to that "troll" with the SDN title "Onco". He is a waste of time and energy to the whole SDN community and in fact the whole world. It appers that essentially everyone on SDN would agree with me. He reminds of the type of person who is an outcast for valid reasons, the type of person who has no life, no friends, and is essentially a nuisance to society. As he even stated himself, if he were good enough to do neurosurgery, he would do so but he states that he is not, so he stated that he is going to do IM or IM/EM. Many of us here on this forum were clearely qualifed enough to pursue Neurosurgery but chose a more mellow field like Neurology. His immaturity is uncalled for and unacceptable. He really needs to get a life and grow up. I have completely refused to waste any of my time responding to any of his posts whatsoever. He is on my "ignore" list. So please do not listen to him. I would much rather that you listen to Gopher's comments, my comments, or others who present valid points and substantiate it with valid reasons.

 

[Methyldopa]

I would think more about whether an R2 that went through a tough prelim a better R2 than one who didn't.

I think that is a good point. But just because you didn't get killed during your prelim year doesn't mean you didn't learn medicine. And that was really my point. If you read my post closely, I state that medicine is a very important part of neurology. BUT you can do an easy medicine year and still learn a ton of medicine.

It's how much you apply yourself, really.

 

[Methyldopa]

The bottom line is that a strong prelim year in medicine will in no way hurt you, and may help significantly if you choose a subspecialty that is more closely linked towards medicine.

I agree with this too. But again a tough prelim doesn't always equate with a strong prelim year. You can have a cush prelim with great attendings and teachers or a tough one with terrible attendings who know very little. That was my point in my first post.

 

[Unsure Person]

I agree with this too. But again a tough prelim doesn't always equate with a strong prelim year. You can have a cush prelim with great attendings and teachers or a tough one with terrible attendings who know very little. That was my point in my first post.

Definitely. If you are getting scutted out all year, with 95% of your work involved with papers, putting orders in, doing social stuff, obviously this is not going to make you a better neurologist. But if you are learning how to really take care of ill patients, how to do a thorough work-up, diagnose, and treat, knowing when to consult specialists and when not to, doing a lot of procedures and signing off on them (procedures that may be of need for you if you pursue a subspecialty of neuro that will require them), attending good conferences and reports that discuss important topics in medicine, ....then in my opinion you will be one step ahead of others who did a totally laid back prelim. When you are on that stroke service as a R1 or R2 in neuro, and your patient has basic cardiovascular or hemodynamic instability, renal failure, or a pneumonia, I don't think you should have to consult medicine to do basic management unless you have initiated the basic work-up and treatment and have failed for some reason. If end up pursuing neuro-critical care or another area of neuro that will be heavy medicine based, your medicine training will definitely come in handy. As I mentioned, the best neurointensivists I know have superb medicine training or are double-boarded in neuro and medicine. But as Methyldopa clearly pointed out, watch out for the "tough" prelim programs that will scut you out and not provide you with a truly solid foundation in medicine. Its tough to distinguish these during an interview day, so ask a lot of questions to make sure you know what you are getting yourself into.

 

[Onco]

From my experience, some of the best neurologists have a very strong foundation in basic internal medicine. I know a handful of people who are double-boarded in internal medicine and neurology, and I can tell you that they are awesome neurologists. But their specialties also are more relevant for internal medicine, e.g neurocritical care / stroke, neuro-oncology which is very medicine based vs movement disorders or dementia that may be slightly less medicine based. The bottom line is that a strong prelim year in medicine will in no way hurt you, and may help significantly if you choose a subspecialty that is more closely linked towards medicine. Also, remember that 2-3 decades ago, neurology was a subspecialty of internal medicine. Logically so, just as many subspecialties of internal medicine require a good analysis of various aspects of the whole body, so does neurology. Perhaps in some of the subfields, it may not make a huge difference. But if you want a broad generalization, I would definitely say that the neurologist with a strong foundation in internal medicine is a better overall neurologist than one who does not have a strong foundation in internal medicine.

I definitely would not listen to that "troll" with the SDN title "Onco". He is a waste of time and energy to the whole SDN community and in fact the whole world. It appers that essentially everyone on SDN would agree with me. He reminds of the type of person who is an outcast for valid reasons, the type of person who has no life, no friends, and is essentially a nuisance to society. As he even stated himself, if he were good enough to do neurosurgery, he would do so but he states that he is not, so he stated that he is going to do IM or IM/EM. Many of us here on this forum were clearely qualifed enough to pursue Neurosurgery but chose a more mellow field like Neurology. His immaturity is uncalled for and unacceptable. He really needs to get a life and grow up. I have completely refused to waste any of my time responding to any of his posts whatsoever. He is on my "ignore" list. So please do not listen to him. I would much rather that you listen to Gopher's comments, my comments, or others who present valid points and substantiate it with valid reasons.

Hmm.. 7 posts in 2 years..

That is adequate evidence to classify a true troll..

 

[neurologist]

Hmm.. 7 posts in 2 years..

That is adequate evidence to classify a true troll..

Hmm . . . 83 posts in 2 months . . .

That is adequate evidence to classify a person without a true life . . . 😴