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Posted by: guest - 12-26-2016, 06:42 PM - Forum: Sub-internships - Replies (2)

Disclaimer: Seems to be chief-dependent and may change with new incoming chiefs.

Structure: 1 week and Children's, 1 week at Denver Health (Level 1 Trauma), 2 weeks at University. You'll be busiest at University. The had a lot of rotators, and they split us up into groups of 1-2 per location.

Children's: Call q2 with one resident and two fellows (this year). A ton of students from other specialties rotate here, and there are only a few call rooms available, so secure one early in the day when you're expecting to stay the night. Operative experience was great with many very complex procedures, with them allowing a great degree of participation. You'll of course do much of the suturing, though something I personally was unprepared for was the lack of clipping hair. Show up at 5-5:30 and prepare a list, gather labs, etc. and preround on your post-op patients. They have 4 surgeons that work there, and the chair is a very colorful character. You can best impress him by following his suture instructions to keep the needle driver open (no palming) and by following generally efficient practices (push, push, pull with the needle already set up for another bite, etc.). The other guys didn't seem to care about that so much. Plenty of opportunities to participate more if you show you know what you're doing. No clinic time really here, and it'd be good to read up on the conferences you'll attend during the week. You see consults and are strongly encouraged to call the attending after working with the resident to report, so get your presentations down.

Denver Health: Call q2 with the night float intern. The chief and another resident (could be research or VA) will take home call, and you'll directly report to him/her after going over your presentation with the intern. Paper charts are used here, so you'll be able to contribute a bit more work, though it will take some digging when you preround in the morning. Operative experience is pretty normal here, where you work with the trauma cases, doing opening and closing.

University Hospital: Call q2-3 with the on-call resident. Chiefs were taking in-facility call here, which was unusual, and they said they want to get rid of that on the interview...but we'll see. You rarely get to sleep here (main competition being Swedish for a multi-state catchment area), which sounds bad initially if you hear about services where you only shadow, but it's truly fantastic experience because of the degree to which you actually get to participate. If you feel like you're only shadowing, something's wrong. You can actively participate in many of the regular ICU procedures, which are plentiful because of the massive NS-ICU. The philosophy here was that you're learning to be a full-fledged physician, and they regularly take over care from other services when they feel things would be better optimized with them as the primary. You, similarly, will be expected to be able to know what to do in a critical care environment for basic problems, and you are expected to pick up the number of patients you can handle and present during morning table rounds with independently-thought-out plans. There is a boatload of attendings here, so you see a very wide variety of approaches (with a similarly varying degree of participation in the OR). This rotation is the money rotation, where you get to know Lilihei (pronounced lilly-high...something I was thankfully corrected on before meeting him) and Breeze. You might not see the PD, Brega, much because she works out of the VA pretty often. You also get some quality time in the endovascular suite, if that's something you enjoy. Finally, at the beginning of your second week, you'll do a presentation here for the residents and attendings without any real "gotcha" questions.

Residents: Generally pretty friendly bunch of folks that will gladly allow you to show your skills with consults, in the OR, and in the ICU. You'll get written off if you don't actively participate, though, of course. Most are married with many having kids. They actively teach you and ensure you're picking up good things to know wherever you end up in residency.

Misc: Cellphone reception was a huge issue for me, mainly in Children's where your call room is separated by multiple floors from the resident call room. Find a spot where you can set it to avoid missing anything. Try to make sure you're around someone with a pager in the other hospitals. I didn't get any time to ski, hike, mountain bike, or anything, but if you wanted to make this your last rotation so you can spend some vacation time in the mountains, that might be something fun to end your sub-I season!

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Posted by: guest - 12-26-2016, 06:41 PM - Forum: Sub-internships - Replies (10)

Sub-I at Vanderbilt. The hospital is a nice facility and is a private hospital, and the children's hospital is beautiful. Nashville is a fun town to be in, but you had better have an appreciation for country music if you want to rotate there (seriously, it was played in virtually every OR). 

During the rotation, there were way too many medical students - 4 away rotators and 4 Vanderbilt students (although the Vanderbilt students were third and second years, due to their new curriculum). It made the rotation challenging in terms of having enough work to do and deciding who got to scrub in to cases, etc., which really took away the ability of sub-i's to shine. There also wasn't a lot of direction for what was expected of you as a sub-I, and there were very mixed signals from the residents about what they wanted you to do or not do in terms of patient care. As a student rotator, you get to do very little in the OR. In fact, most of the time, sub-i's served as pseudo-scrub techs, and even then, some attendings asked that you not touch the instruments. On one or two occasions, you might get to suture or put on a Raney clip, if you were lucky.

The attendings were friendly for the most part but generally didn't interact much with students. There generally wasn't much of an emphasis on teaching, as compared to my other rotations, from the attendings and from the residents. You only go to clinic once, and it's with Dr. Thompson. Dr. Lola Chambless was great though and met with students to provide guidance on ERAS, which was extremely helpful. The residents were okay - other than the current group of third year residents who were great, there were some that were just hard to get along with as a medical student and didn't seem to get along with the rest of the residents either. 

Also, to comment on a couple other topics brought up in this forum... First, regarding locations that favor sub-i's, Vanderbilt is certainly not one of them. In fact, they don't interview many, if not most, of the sub-i's. Second, the letter from Dr. Thompson took over a month to receive and was only a few sentences long.

Sub-i at Vanderbilt - I disagree with some of the above, so thought I'd toss in my two cents below for those considering a rotation.

General: You have to earn your respect and place on the team as a sub-i at Vanderbilt. I found that there is a lot for sub-i's to do but you need to be proactive without asking the time old question "how can I help" all the time - figure it out. They let you function as the intern and will ask you to run the list with them at the end of the day rather than the intern or NPs if you demonstrate your abilities. If you are taught how to do something, then know it the next time - gather all the supplies for an EVD (ie make a list of what they use at Vanderbilt the first time you help with the procedure) and you'll get to do the EVD next time, pulling drains, closing cases quickly, how a certain resident/attending likes something, etc. Basically, show you pay attention to details and you'll do more. Ask the younger medical students about how to run their EMR - they can definitely be helpful. Vanderbilt has their own. It is different and takes some getting used to.

People - Strongest selling point in my opinion. The entire program is very friendly and down to earth - faculty and residents. Faculty really go to bat for the residents. Most faculty love having students around in the OR- some less so. Just read the room. If you have earned the resident's respect, they will include you. Chambless' application prep session is very helpful if you rotate before ERAS is due.

Research - Lots going on, especially in sports concussions, peds, and spinal/tumor outcomes. If you want a clinical project while you are rotating to demonstrate further interest in the program, ask around. Plenty to do.

Talk - I think it was like 7 or 8 mins long plus a few mins for questions; don't really remember exactly. Pretty benign, but you will be asked some questions. The questions seemed to be more to gauge your reaction and how you handled yourself than really caring about the specifics of your answer.

Call - q4. You're busy but not exhausted. Essentially one sub-i on every night and you rotate one week on each of the different services. Had a couple of days off to explore Nashville over the course of the month. Some awesome food/live music. Go to Hattie B's Hot Chicken - walking distance from campus.

Typical day - come in around 4:30/4:45 - List ready by 4:45/5:00 (by the way for those new to sub-i's, if they say list ready by 5, they mean 4:55. Don't be late.). Round with the junior resident. Some days you'll see a couple of ED/floor patients if they trust your exam and census is bigger than usual. Run the list as individual teams. Quick and efficient. Go meet your patient before the case. Breakfast with all the residents around 7:15 before OR starts at 7:30. Cases all day. PM rounds once done for the day. Update the resident about the patients on your census (sometimes they'll ask you and sometimes they won't). Go home around 8.

Interviews - For what it's worth, they said at interviews that they didn't want to waste people's time. The sub-i functioned as the interview in their eyes and coming back for interview day was more of a formality.

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Posted by: guest - 12-26-2016, 06:39 PM - Forum: Sub-internships - No Replies

During sub I you are not required to take night call, but you will likely have to take weekend call (although it can be only once or twice during the month if there are a lot of other Sub Is rotating). The residents are great to work with, and most of the faculty do a great job of teaching (a few less so than others, but not outside of the normal distribution). Most importantly, the residents are awesome. The chiefs and juniors teach the whole time and let you participate in operations as much as they can. That being said, you do more when you work at the community hospital (Bellevue) than when you are working at their main hospital, but you open, make burr holes, open dura and close on a regular basis. The large element that is missing (although maybe not missed) is the floor work. The floors are largely taken care of by a PAs and NPs and in the morning there are no patient presentations beyond a quick rundown of overnight events. Because of this system, you may have to help out with consults after a long day in the OR, but there is no real independence; it's a team effort. As far as program structure goes, research is not the main focus, and that is made obvious by the lack of guaranteed research time. That being said, residents publish, and NYU in general has a huge research environment, so they are trying to move in that direction. If they want to maintain the same amount of resident coverage they have now AND have a dedicated research year, then they probably need 3rd student each year, something that has been "in the works" for a while now. Overall: chill sub I, good experience, and the program is on the rise (has been attracting some big names over the last few years)

source: did a sub i there

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Posted by: guest - 12-26-2016, 06:38 PM - Forum: Sub-internships - Replies (7)

Overall impression: nice place

Attendings and Residents were always great to talk to and valued the sub-is input, which was refreshing.

The Sub-I experience is devided into 2 main hospitals i.e. 2 weeks at Zales Lipshy hospital and 2 weeks at Parkland Hospital - both hospitals are connected (for now - a new Parkland hospital is almost completed)

At Zale-Lipshy hospital, you spend your one week on the Tumor service with primarily Dr. Mickey, Dr. Barnett and also dabble in some functional/DBS procedures with Dr. Louis Whitworth. Side note: Dr. Mickey is one of the nicest physician I've ever met. Dr. Barnett is great too; both are very approachable and seemed interested in teaching.

You spend the 2nd week on vascular service with Dr. White (PD), Dr. Welch, Dr. Rickert and Dr. Batjer (chair) - an amazing team; they clipped an at least one aneurysm per day while I was on this service - maybe this was just my lucky week; along with endovascular procedures. I saw a 3cm "ICA" aneurysm clipped (large enough to cause visual problems)!!! now that's something cool to see. Open cerebrovascular procedures are starting to become a thing of the past, but UTSW is a place where you can still see the procedures done by individuals who are competent in the field. You don't have to take calls these 2wks, but it will only look good if you do.

You then spend the other 2wks at Parkland hospital, which is primarily their trauma hospital. Here, you'll see a wider variety of cases, injuries and GSW, afterall you are in the heart of Dallas, a major metropolitan. You get to take calls at Parkland and you can take as much as you want - there's typically just one of other sub-i at parkland with you, so enough cases and face time to go around. They require at least 2 calls, but it makes sense to do at least a Q3.

You don't have to write notes, but 4H&Ps are required by the end of your rotation - this can be in email form, but it's easier to just do it in EPIC and assign the attending as co-sign.

There's also a presentation (not grand round) that's typically given on the Wednesday evening your final week. It's not malignant, but they'll ask you reasonable questions - which I liked because you'll get to talk about your research by people who are not trying to stomp you.

At both places, you come in at 5AM (or earlier, if you were slow like me), see your assigned patients and the residents will ask you about them at 6AM when they do their rounds. OR starts at around 7:30AM, seeing 2 to 3 procedures that day. On some days, I scrubbed on all cases and assisted quite a bit; while others I only scrubbed on one case. It all depended on the acuity of the patient and how many residents were interested in seeing the case. Usually towards the end of each case, the attendings/chiefs would scrub out and let the junior and sub-i close the wound i.e. after the dura has been put back together. If there was no junior in the OR, the sub-i and the chief would close.

The day typically concludes around 7:30PM (ranging from 6PM-9PM) if not on call.

Hope this helps. 

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Posted by: guest - 12-26-2016, 06:34 PM - Forum: Sub-internships - Replies (2)

Rotating at Michigan was fantastic. The faculty are some of the nicest people I've ever met, which can be surprising at first since they're all so accomplished. It was a fairly solid operative experience as a sub-i, especially if you are proactive about getting in the OR with the same attendings so that they get comfortable with your skill set. You do a week of neuro ICU during your rotation, but you can leave after ICU rounds and go back to the OR most of the time. They also assign you a mentor in a subspecialty that you're interested in at the beginning of the month. You spend a day in clinic and a day in the OR with your mentor each week. They encourage you to spend 40% of your time in clinic, but I just spent the day in clinic with my mentor.

If you're interested in midwest programs and/or are interested in basic science research, this would be an excellent choice, and I highly recommend it. The program director is one of the most humble, down-to-earth people I've met, especially considering how accomplished he is. Also, I've heard that Muraszko writes great letters, so that's obviously an added bonus. Oh, and they interview you while you're there - definitely pluses and minuses to this, but it frees up another interview date and saves you travel to Ann Arbor which is nice.

So recently rotated at Michigan.

Overall, pretty good experience. Definitely a more 'gentlemanly' program compared to some of the other top-notch programs that put sub-I's through the grind.

Operative: you go to the OR every day except the day that you're in clinic with your mentor (typically this clinic day is 1/week). In the OR, depending on the level of your resident, you can either help open/close, or you can do absolutely nothing (even while scrubbed in). Also depends on what time of the year you do your sub-I. In july/august you won't do anything since everyone is adjusting to their new responsibilities. But if you do it in May/June you have a ton of opportunities.

Services: There are at least 5 or 6, including vascular, spine, NICU (no operating room time), tumor kahn, tumor peet, and functional. You are required to go to the cases of your specialty, although if you happen upon a day where there are no tumor cases and you're on tumor, then you can go to a spine case. Just talk amongst co-sub-I's to figure things out. The vascular service is pretty much concentrated in the IR suite--not too much open vascular anymore. Spine is huge at Michigan. Paul Park and Frank LaMarca are doing cases 3-4x/week and other attendings do simple cases every now and then (think discectomies, lamis, etc). On Friday's, Dr. Levin does cases at Michigan (she's usually at the VA) and she does a lot of teaching. In terms of tumor, Michigan is still trying to build up its tumor referral base. Orringer and Heth are the main tumor folks. Functional nsu is run by Sagher, who used to be PD.

Day-to-Day: expected to round on ICU-only, starting at 6am on weekdays, and full kahn/peet list at 7am on weekends. Thursday you round earlier because of grand rounds (5:40am). On ICU rounds, expected to carry 1 or 2 patients, but honestly the residents didn't really care too much. Presentations are full-ICU systems-based presentations. After rounds, you either have time for breakfast if you rounded quickly or had few patients, or you go straight to OR. Residents love having you around, but don't really care about where you are at any given point. For example, you can find yourself done with cases at 5pm and your residents won't care about where you are or what you do (i.e. see consults if you want, or go home if you want). Expected to show up on 1 weekend day per weekend, but just to round (unless you are on call).

Faculty: super supportive, and will try to recruit you to Michigan. You interview while you're here, and while you don't interview with everyone, you will interview with the residency selection committee heavy hitters (Maher, Thompson, Sagher, Murazko). You have to bring a copy of your CV to each interview (some folks didn't do this, but I did because why not). You get assigned a faculty mentor which is either super awesome or neutral. Thompson/Park are awesome mentors while some of the other more busy folks may not be as helpful/communicative.

Residents: some of them are flat out awkward, but ALL of them are super nice, friendly, and eventually make great fellowship candidates (almost everyone does a fellowship...). The 6's and 7's are all really good and can operate well. The 2's and 3's needed work. They don't really expect much out of you--ZERO floorwork, so anything you do (like remove sutures/staples) is viewed as world-changing.

Research: 2 dedicated years w/o true protected time (still take call and cover cases). Seems to be skewed to basic science, but there were some other awesome clinical projects going on.

Location: Ann Arbor is a quiet suburban town bordered by nobody-towns except detroit (45 min away). Housing is actually pretty pricey since most people in ann arbor are university workers who are paid well. You can find 3br homes that are 20 years old for 165K. Other cities have more affordable housing for sure, but there are obviously other cities with much more expensive housing. I will say, if you want a specific type of housing, you'll find it: cheap apartments, expensive apartments, cheap houses, mansions, etc.

Program: overall it's an awesome place. There's a reason everyone loves Michigan. Pretty good rotational experience as a sub-I, not so much because of the actual work you do there, but because the foot-in-the-door that you establish as a Michigan sub-I.

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Posted by: guest - 12-26-2016, 06:31 PM - Forum: Sub-internships - Replies (10)

Rtation at Miami. Here's a summary of the experience.

Hours/Workload: Very heavy workload for medical student rotators. Responsible for generating patient lists in the morning, meaning you get in around 3:45-4:15 a.m. Often wrote patient progress notes. Easily worked 100-110 hours a week. Call Q4, and you often stay on post-call days. Work most weekends, depending on how many other sub-i's there are.

Hospitals: Jackson Memorial Hospital is HUGE with something like 1500 beds. It's the public hospital and tied to the Ryder Trauma Center. The catchment area is also very large and includes South Florida, the Keys, and some of the Caribbean and Latin America. Because of this, you get exposure to a diverse array of cases. You also have the option to rotate at the University of Miami Hospital for a week, which is the private hospital, or Miami Children's Hospital, where the residents do their pediatric neurosurgery rotation. Residents also rotate at the VA, but students don't rotate there for neurosurgery.

OR: There are plenty of OR starts, easily between 6-8 at JMH a day, with great cases to see. You get to see pretty much everything - open vascular, complex tumor, functional, spine. As a medical student, you often get to suture and assist with opening/closing, more or less depending on who you are working with.

Clinic: You get a chance to work in both Heros' and Morcos' clinic weekly, which are great experiences. You also work in the resident clinic once a week and see patients.

Overall Impression: The residents seem pretty close overall and were generally easy and fun to work with. The attendings were friendly and collegial, although as other posts have suggested often very sub-specialized. Definitely not a malignant program, although Heros, the current PD, has been known for his tough love. The rotation is very busy, but a great learning experience.

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Posted by: WashU - 12-26-2016, 05:56 PM - Forum: Sub-internships - No Replies

Anyone rotate at WashU

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  Interview swap spreadsheet
Posted by: swapme - 12-26-2016, 10:28 AM - Forum: Interview swap - Replies (147)

Put your requests here


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  Question about board certification
Posted by: dispo - 12-26-2016, 12:41 AM - Forum: General Discussion - Replies (4)

So, it's my understanding that some time after you complete neurosurgical residency you can take a multi-day test and get board certified by the ABNS. What I don't understand is what it means when I hear 3rd and 4th year residents taking "the boards" for credit. Are these components of the same board, or is this something different? I realize this probably seems super ignorant to many of you, but I've never gotten a clear answer on this and would love some clarification.

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  Help Wanted!
Posted by: socrates - 12-25-2016, 11:56 PM - Forum: Uncle Harvey Back! - No Replies

Either register an account and PM me or email the admin at admin@neurosurgeryhub.org if you are interested in helping here.  

As suggested, we will keep the anonymous forum posting enabled.
Having reliable mods would be nice.
Also, contributing to the wiki and educational materials.

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