Some people may not know about or think of Mizzou (in Columbia, MO). Those that do know of it have likely heard it is a very malignant program. 

I completed my sub-I at Mizzou last month, and can gladly say the experience was very positive. 

This post is really meant to highlight a shift in culture that has occurred over the last few months. A new chairman has taken the helm, and he is legitimately one of the nicest physicians I have ever met (across any specialty). Of course it is not enough to be nice. He is also a very well respected surgeon with hundreds of papers and citations. My experience with the other attending physicians was also pleasant and cordial, and they all were willing to teach me when time allowed. 

As far as the residency program, there is room for 1 resident a year. This, however, is supposed to change as the new chair develops and builds the program. The residents were all nice, willing to teach, and easy to get along with. I also saw the residents have (what seems like) a tremendous amount of autonomy in the OR (but of course this is relative, since it was my first sub-I). 

I really think this program is going to become a hidden gem with the new chairman. I have many friends that spent time with the NSG department in medical school prior to the change in leadership. Their experiences were universally bad and reflected the malignant culture the department had a reputation for having at that time. Since the change in leadership, both myself and other medical students have had excellent experiences. 

So, to any reading this that are applying to NSG residency next year, I believe it would be very smart to consider (or reconsider) Mizzou as a place to complete a Sub-I. To any applying this year, understand that the program's history of a malignant culture is dead. This is not just my experience, but comes from the word of all the residents as well.

Would it be a bad idea to squeeze in a third sub I during September? I would be applying for it now. Just really interested in their program. Already getting a LOR from my two sub-I's which will be before ERAS submission. 

Thanks

Anyone have thoughts on the new doximity rankings? There was definitely some movement of programs outside the top 5-10..

Just came across this book by one of the most accomplished neurosurgeons today. 

https://www.amazon.com/dp/0310363659/ref...ljaz10cnVl


He'd put all of you to shame. Maybe you can read the book and learn.

What happens if a resident is deficient in one or more of the ACGME minimum cases? Can the PD still graduate that resident?

How is the averge pubs 26 and the average step 2 score 255 ? If this is average, are all applicants at USC, UW, UPitt, UCSF 275+ rockstars with 100+ pubs ?
Also why so few matched individuals with AOA ? 

Also, how are 60+ USMD going unmatched ? I don't want this to come off wrong but us grads should be priority. They can't just go somewhere else and train to become a neurosurgeon while having 500K+ in debt

What are your thoughts ?

Finishing up Rene Girard’s “Things Hidden Since The Foundation of the World” and Holy ****!

This is to Psychology/Sociology what “Descent of Man” is to Biology and what “Principia” is to Physics. Arguably the most red/black pill book of all time. It is Peter Thiel’s favorite book of all-time and what made him become the first outside investor in Facebook since he understood the power of Mimetic Desire and how Facebook would harness that power. Tread lightly though….it will likely rewire your brain and alter your life about 4 chapters in.

tl;dr - after the basic necessities in life (food, shelter, etc.) we desire things because others desire them, not because we intrinsically desire them. In fact we can’t intrinsically desire anything. All desire is imitative throughout our entire lives from our parents, to our peers, to celebrities, etc.

Shortest video I could find that accurately explains it:


https://youtube.com/watch?v=OgB9p2BA4fw

Applying that to specialty choice - Competitive specialties are competitive in large part because they’re competitive. Medical students see that X specialty is competitive and surmise it must be a good speciality not realizing that it may not be a good speciality for them. Often times students who do well in med school feel they need to apply to a competitive field to validate their achievement. This drives up more interest and the cycle continues.



People often chalk up competitiveness of a specialty to a combination of money and lifestyle but ignore the most important component - the competitiveness itself (a proxy for prestige and desirability).



Students that apply to non-competitive fields are either limited by scores/grades/school but more often have other models of desire that outweigh the ones of chasing pure desirability. For example someone may want to model their career after their hometown pediatrician who took care of them and their siblings and that mimetic desire is stronger than the potential mimetic desire of the top students in their class wanting to go into surgical sub specialties.


The important thing is to realize that you can’t escape mimesis but instead you should choose your models of desire carefully. Additionally you should focus on thick desires (values that are related to your core being) rather than thin desires (fads and trends that the crowd is going for)


Luke Burgis talks more about this here

https://youtube.com/watch?v=dtBtov2f7e4

Tragic

Rant ahead. Decided on NSRG late MS3. Now MS4 on Sub-I's. Everyone is a rockstar. Knew they wanted this 4-5 even 10 years ago in high school. Publications and all that over years of dedication.

And I'm here with average grades, almost no research, and honestly I'd feel like crap if I got in at this point cause I haven't demonstrated any commitment to this.

Honestly, I like it as much as any medical student could without having any real responsibilities. I don't mind the hours for now but who knows 10-15 years later.

Pardon the dumb analogy, it's like why "date" me when there's someone else available, more passionate, and more prepared for what's to come?

I can't stop thinking over and over in my head. I haven't shown any real commitment to this. I haven't contributed anything to this. I hide behind a constant veil of faked intelligence because I'm a decent memorizer and can select A, B, C whatever better than most people but I'm not creative at all.

Then I start to question my motives and even though I consciously deny it's for the pride, ego, "grandiose sense of self importance", however you want to define narcissism I can't help but think maybe I'm doing this for external validation that I'm an otherwise nobody.

Maybe it's for the validation from people I'm afraid to even make eye contact with of wearing scrubs that say "low self esteem resident M.D. neurological surgery" on it.

Thanks for reading my dumb thoughts. Good luck 2023 match cycle to those on the trail. I hope I'm not the only one who feels this way.

Have they? I've been reading about them. Or just hype?

https://www.nytimes.com/2018/01/08/health/surgery-3d-microscope-moyamoya.html

I want to be a neurosurgeron so fucking bad