I am kind of in a dilemma and am looking for some advice/encouragement/similar experiences, etc…

In scheduling my 3rd year rotations, I have an opportunity to do an NS rotation early within the year (January).  Problem is, I will only have had OB/GYN and FM (plus 3 months research).  My clinical affairs dean was kind of discouraging me from doing an NS rotation early, especially without doing GSurg first.  Thing is, I don’t have any more elective time 3rd year to explore NS and develop my interest before 4th year sub-Is.  I’ve talked to the NS chair, who said he tailors his 3rd year rotation to really be on a 3rd years’ skills/knowledge level, which is encouraging.

At this point, I’ve gone ahead and scheduled my 3rd year NS rotation.  I’ll have had some operative experience with OB/GYN, plus I’ll have 3 months of research time to be doing some side reading, etc… to prepare.  Additionally, I hear the skill set for NS is quite different, and that not having GSurg may not hurt me that much. 
Anyone have any advice on prepping for this rotation?  What to read, what skills to practice, etc… Am I totally nuts for scheduling this and just setting myself up for some major disappointment?  (It really is the only option I have, though)

Boner, your story is quite similar to mine. I actually did Neurosurgery in November my 3rd year, having done only ENT, ophtho, neuropath and peds. Then ended up doing a home sub-I in February, after having additionaly only done neurology and interventional neuroradiology (admittedly helpful and relevant). Thus, had not even done medicine or surgery. For me it worked great, as I had tried out all the things I was interested in early on, could make solid plans for appropriate away rotations, etc, while catching up on my other requireds. Most school probably wouldn’t allow it, and it wasn’t entirely by choice (lottery scheduling system), but it couldn’t have been better. Of course, I was not the best analyzing ABGs or EKGs, but no one cared. I did lots of suturing and knot tying practice at home. For study, I’d start with neuroanatomy/neuroradiology. Aim to be able to intelligently describe the location and expected symptoms of any lesion on an MRI or CT. Some good UH threads elsewhere on books. Keep your greenberg handy at all times. You could also see if these are any use…

http://www.med.harvard.edu/AANLIB/home.html
http://www9.biostr.washington.edu/da.html

Stem Cell - 09 April 2009 07:15 PM

Boner, your story is quite similar to mine. I actually did Neurosurgery in November my 3rd year, having done only ENT, ophtho, neuropath and peds. Then ended up doing a home sub-I in February, after having additionaly only done neurology and interventional neuroradiology (admittedly helpful and relevant). Thus, had not even done medicine or surgery. For me it worked great, as I had tried out all the things I was interested in early on, could make solid plans for appropriate away rotations, etc, while catching up on my other requireds. Most school probably wouldn’t allow it, and it wasn’t entirely by choice (lottery scheduling system), but it couldn’t have been better. Of course, I was not the best analyzing ABGs or EKGs, but no one cared. I did lots of suturing and knot tying practice at home. For study, I’d start with neuroanatomy/neuroradiology. Aim to be able to intelligently describe the location and expected symptoms of any lesion on an MRI or CT. Some good UH threads elsewhere on books. Keep your greenberg handy at all times. You could also see if these are any use…

http://www.med.harvard.edu/AANLIB/home.html
http://www9.biostr.washington.edu/da.html

Thank you, Stem Cell.  I really appreciate the advice and encouragement!

Building off this....

I don’t know how most places work it, but it was told to us from the clerkship director panel that expectations and what’s required to honor a certain rotation varies based on what time of the year it is.  They change their expectation of 3rd year students based on which segment of the year we are in. We have 6 segments to the year. You have to do gen surgery and your surgery sub-units (neuro is an option) back-to-back in 12wks.  I see several schools of thought to this:

1 Do surgery late but not latest (in order for 4th year scheduling)
pro: You know the most
con: You are expected to know more and in general more people interested in surgery do this so it will hard to shine
and things can get tense between students

2 Do surgery first (hopefully gen surg b4 surgery sub-units within the 12 wks)
pro: Less is expected of you. I am fairly familiar with the OR already, and in general people are less interested in surgery. You can shine. If you are not expected to know much and everyone else is doing it to get it out of the way then you theoretically have an opportunity to look better then most.  Plus, you still have to come back for a month of NS AI in 4th year meaning you can show improvements then after a good energetic first impression.
con: u don’t know anything.

Thoughts? what worked? what didn’t? etc…
Thanks.

thats an interesting was to look at it. I can either take NS 1st block of third year or third block (I am leaning towards third block right now) but after thinking about it,maybe it is easier to get honors taking it first. Yuk I hate deciding the rotation electives!

I’d think 3rd is better than first or late. Good to learn the basics about life on the wards on a less critical rotation so you can be efficient, effective and helpful on NS. Particularly after my PhD I was a bit of a deer in the headlights when I first hit the wards not knowing how to navigate the computer system, or even what I was supposed to be doing or looking for in it! Frankly I had forgotten a ton of medical knowledge in 4 years, though found you fairly quickly pick up what you need to know. I’m just glad I was asking the REALLY stupid questions on ENT, and not NS.

Stem Cell - 10 April 2009 04:50 PM

I’d think 3rd is better than first or late. Good to learn the basics about life on the wards on a less critical rotation so you can be efficient, effective and helpful on NS. Particularly after my PhD I was a bit of a deer in the headlights when I first hit the wards not knowing how to navigate the computer system, or even what I was supposed to be doing or looking for in it! Frankly I had forgotten a ton of medical knowledge in 4 years, though found you fairly quickly pick up what you need to know. I’m just glad I was asking the REALLY stupid questions on ENT, and not NS.

thanks!!

As a 3rd year, no one will expect you to know what’s going on.  The residents and attendings realize that you’re there to gauge your interest in Neurosurgery so as long as you show up on time, work hard, and try not to be annoying, you’ll do well.  You’re immediately hamstringed as a med student anyway so you’re residents shouldn’t expect anything but effort.  Your sub-I is where you will be expected to take on more responsibility but even then, effort and personality will go much farther than knowing shit.  In short, it’s my opinion that it doesn’t matter when you take the 3rd year elective though if you take it early and don’t like it, you’ll have more time to find another specialty.

perhaps it does not fit to that topic, but what are you thinking about a clerkship at Beth Israel Deaconess Medical Center? they have a very small faculty and no residency programm, but could it be nevertheless helpful? does somebody can say something about the faculty and made already a clerkshipe there?

Sorry to dig up an old thread, but I had a question about a piece of advice from Stem Cell:

Stem Cell - 09 April 2009 07:15 PM

I did lots of suturing and knot tying practice at home.

Did you mean you got a lot of practice in at your home institution or at your actual home/apartment? If the latter, any suggestions on what medium to practice suturing technique? I’ve heard of, and used, pig’s feet/oranges/bananas, but they generally don’t give you a good approximation of actual tissue resistance and manipulation (e.g. can’t throw sub-Q stitches worth sh*t on pig’s feet). Any advice would be greatly appreciated!

Phantom, at your stage, first learn to throw two handed and one handed ties correctly and efficiently. Typically during rotations, the residents will throw the stitches and then let you tie. If you can show them that you can tie properly they’ll start letting you/teaching you how to suture. I’ve tried the pig feet and fruit and they’re all very poor approximations - I feel they’re worthless as practice. If I were you (and this is what I did) I’d just practice tying. Get some packets of silk thread and just go to town. Then have the residents show you how to throw a needle. I found throwing stitches much easier than training your fingers to throw knots properly and efficiently. You’ll have at least 3 rotations worth of time to learn how to stitch, which is plenty and besides, no one expects you do know anything anyway. Show them that you’re a good learner.

Best thing to do, get as much hands on experience suturing during a gen-surg rotation (if your school allows, try to spend some time with the ENT guys so you know how to close the neck well - it’ll look very impressive when you can close and ACDF on your own!).

Thanks for the advice… Luckily it’s exactly what I’ve been doing since first year. I’m at a school that has no home program, but it’s been working out well since there are no other students/residents to compete with for cases. While I do lose a lot of the peer-to-peer interaction and teaching that only residents can give, I have been lucky enough to work with a few great PP guys that enjoy teaching. Had a lot of problems with air knots first year until I really started focusing on keeping firm and directly vertical traction on the post… Helped out immensely!

I’ve become (at least semi-) decent with throwing and tying sutures on deeper layers (spine and cranis) or any interrupted sutures, as they let me do those layers most of the time on closing. The thing I really struggle with is the sub-Q running closure… Anytime they’ve given me chances to practice, though, it’s either 0300 or we’ve been there for 6 hours already and everyone is anxious to finish. I don’t want to hold everyone up so I always end up deferring to the surgeons for the sake of time. Any suggestions on practicing these, or is this just another one of the million techniques that will have to come with repeated exposure?