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Can anyone speak to the north east programs that aren't the "big name" places typically talked about here? Dartmouth, Tufts, BID, Yale, Sinai, Einstein, etc? Do these suffer from being in a compact area or near the NYC/BWH/MGH programs? Which have better research, autonomy, operative experiences, etc?
(05-23-2020, 01:09 PM)Guest Wrote: (05-23-2020, 12:46 AM)Guest Wrote: (05-22-2020, 09:34 PM)Guest Wrote: (05-22-2020, 01:42 AM)Guest Wrote: Can any rotators from the previous few cycles describe their experience sub-I'ing at USC in a bit further detail than whats on these threads? (i.e. what sub-i expectations are, what resident life is like, what the resident culture is like, what the operative experience is like with regards to teaching and mentorship, etc.) Is the autonomy dangerous as "advertised" by some on this forum? Or do the chiefs come out well-trained and is the autonomy graded?
USC is truly a neurosurgical gem and the premier program in LA. Sub-Is rotate at both of SC’s main hospitals: Keck (private hospital, all the attendings work here, no ED) and County (public hospital, 7s serve as the attendings, largely poor/Latino patient population, busiest trauma center in the country, #1 trauma surgery/EM program in the country). Call is typically q3 for subis and residents (mostly the 2s) and you stay late on your post all day. This schedule is mostly the case for county rotations, but can also be the case at Keck. Unlike some hospitals where the neuro ICUs are run by NPs/PAs or ICU attendings or pulm/crit or neurology, the neuro ICU at county is essentially run by neurosurgery interns (they spend about 9-10 months of intern year there). Now this either jives with you or it doesn’t. You can either view it as an outstanding learning experience, or as a ploy for the county system to save money. Because of the high trauma, the main objective of junior residents is to learn everything about bleeds and how to control them. What they say about autonomy is true. This is especially the case when you are a 2 since you are paired with a 7 for basically the whole year at county and if your chief doesn’t want to come in one night/thinks you’re sufficiently capable when there’s an emergency case, then your basically all alone (with limitations of course). I would say teaching at SC is moderate. I can think of few times when an attending has taken the time to explain clearly the steps of the case or pimp/ask you to recite indications/challenging aspects/steps of a case. That being said, attendings are very approachable and always willing to put time aside to talk/answer questions/help. But I would say there is a general aversion toward spoon feeding that is readily evident (that is also shared by the residents). The 5s are the chiefs at Keck and it is not uncommon at all for them to work 6+ weeks without a day off or work till 10pm on your postcall day (40 hour shifts). This is NOT due to any pressure by the department or attendings. It’s honestly just because the residents care so much about what they do. Overall, the diversity of pathology is unparalleled, and few programs around the country rival USC’s volume. The residents get along well, and I mean, you’re living in sunny LA.. What more could you possibly ask for?
Sounds like you won't really ever see that sun.. or LA. While USC is undoubtedly a top tier program (and the best in Cali behind UCSF), there are some significant downsides. First, if you're interested in an academic career, you need at least *some* time to move forward with building a research niche. Obviously, any clinically busy program is going to have long hours. I train at an operatively heavy program and the best time to finish papers, have research meetings, write grants, etc. was during my post-call days. It definitely sucks and you feel tired but it at least allows you to remain productive and be competitive for funding down the line. If you're taking Q3 call with no post-call day, you're never going to be able to do that. What good is an internal R25 during your 1 free year if you aren't able to lay the groundwork for any real research during that time? While you can always justify any extra time in the hospital as more time with patients, you can't deny that a resource-poor hospital with no support staff and an open ICU adds a lot of unnecessary pain and opportunity cost.
Bottom line - top tier program with amazing training, but you can get comparable operative skills with a lot more time for academic pursuits and a lot less suffering at other places.
USC resident here. Some thoughts to counter these points - you can't learn to operate as an attending for the first time (or at least I think most people would agree that they want to be well trained leaving residency and not have to rely on fellowship to learn what they should've learned the past 7 years). So its good to be operatively busy as a resident is a strength. It is true there are other places that can train you comparably with more academic time, but not many.
USC has a few months during PGY4 and PGY5 year (4 months on gamma knife as PGY4, 4 months research as PGY5) to lay the ground work for a PGY6 R25 year (if desired) which is plenty of time to be successful. By this point you have a career trajectory in mind (usually) so you aren't waisting your time doing glioma lab research as a PGY2 research year to ultimately want to be a spine surgeon.
County call is q4, not q3. That makes a big difference. Keck call is more like q5 home call (can still get slammed, the 'home' part can be misleading). Also I wouldn't refer to us as a resource poor program. We are not Barrow/Mayo where there is more money than you can spend. But we have PAs/NPs that help with lots of 'scut', and aren't drowned with mountains of paper work. I would say we are average with resources. Keck ICU is mostly run by neurocritical care, County is mostly by NSG. We work as a team in both places. We also have Pulm Crit care around. It is not a helpless intern trying to experiment and figure it out, we have help. As for teaching didactics, its not as often as other places and I do think its certainly fair to say theres not a lot of spoon-feeding.
USC has a long history of pumping out academic neurosurgeons, as the majority of the grads do go into academic careers. Many are in high level positions are reputable programs across the country right now, and that has its perks when its fellowship time. Several of their residents who are academically minded find time to pump out lots of publications (50+). The above poster is correct however, it is usually required to make a larger effort on the resident's part during postcall/quiet call nights. Admittedly, those are usually clinical papers and not Cell/Nature papers, but very few programs are having residents publish in those journals, certainly none in the 'operative heavy' category.
Ultimately I think the above posts are both correct and make good points. But we find time to have a life outside of neurosurgery, we certainly do get time out to enjoy LA, and we are a happy and cohesive group. We are most likely among the busier programs out there, and the autonomy people talk about I agree we are certainly on a far end of the spectrum but it has never been unsafe. We have the foundation to get you an academic career if that is what you're looking for. We try to minimize the pains of a busy program as much as possible, but residency is pain at the end of the day. Come spend some time with us if you want to see for yourself.
This is a great response. I'm sure that the medical students applying will really appreciate the additional info. I agree that outside of Mayo/BNI there aren't any places that will get residents to that level of operative skill with less pain. USC and UCSF are the best programs in Cali for operative training.
All the cali programs are excellent
(05-22-2020, 12:37 AM)Guest Wrote: Can anyone speak to the North Carolina programs
Also interested. WF/UNC/Duke/Carolinas anyone have similar in depth information?
(05-23-2020, 01:09 PM)Guest Wrote: (05-23-2020, 12:46 AM)Guest Wrote: (05-22-2020, 09:34 PM)Guest Wrote: (05-22-2020, 01:42 AM)Guest Wrote: Can any rotators from the previous few cycles describe their experience sub-I'ing at USC in a bit further detail than whats on these threads? (i.e. what sub-i expectations are, what resident life is like, what the resident culture is like, what the operative experience is like with regards to teaching and mentorship, etc.) Is the autonomy dangerous as "advertised" by some on this forum? Or do the chiefs come out well-trained and is the autonomy graded?
USC is truly a neurosurgical gem and the premier program in LA. Sub-Is rotate at both of SC’s main hospitals: Keck (private hospital, all the attendings work here, no ED) and County (public hospital, 7s serve as the attendings, largely poor/Latino patient population, busiest trauma center in the country, #1 trauma surgery/EM program in the country). Call is typically q3 for subis and residents (mostly the 2s) and you stay late on your post all day. This schedule is mostly the case for county rotations, but can also be the case at Keck. Unlike some hospitals where the neuro ICUs are run by NPs/PAs or ICU attendings or pulm/crit or neurology, the neuro ICU at county is essentially run by neurosurgery interns (they spend about 9-10 months of intern year there). Now this either jives with you or it doesn’t. You can either view it as an outstanding learning experience, or as a ploy for the county system to save money. Because of the high trauma, the main objective of junior residents is to learn everything about bleeds and how to control them. What they say about autonomy is true. This is especially the case when you are a 2 since you are paired with a 7 for basically the whole year at county and if your chief doesn’t want to come in one night/thinks you’re sufficiently capable when there’s an emergency case, then your basically all alone (with limitations of course). I would say teaching at SC is moderate. I can think of few times when an attending has taken the time to explain clearly the steps of the case or pimp/ask you to recite indications/challenging aspects/steps of a case. That being said, attendings are very approachable and always willing to put time aside to talk/answer questions/help. But I would say there is a general aversion toward spoon feeding that is readily evident (that is also shared by the residents). The 5s are the chiefs at Keck and it is not uncommon at all for them to work 6+ weeks without a day off or work till 10pm on your postcall day (40 hour shifts). This is NOT due to any pressure by the department or attendings. It’s honestly just because the residents care so much about what they do. Overall, the diversity of pathology is unparalleled, and few programs around the country rival USC’s volume. The residents get along well, and I mean, you’re living in sunny LA.. What more could you possibly ask for?
Sounds like you won't really ever see that sun.. or LA. While USC is undoubtedly a top tier program (and the best in Cali behind UCSF), there are some significant downsides. First, if you're interested in an academic career, you need at least *some* time to move forward with building a research niche. Obviously, any clinically busy program is going to have long hours. I train at an operatively heavy program and the best time to finish papers, have research meetings, write grants, etc. was during my post-call days. It definitely sucks and you feel tired but it at least allows you to remain productive and be competitive for funding down the line. If you're taking Q3 call with no post-call day, you're never going to be able to do that. What good is an internal R25 during your 1 free year if you aren't able to lay the groundwork for any real research during that time? While you can always justify any extra time in the hospital as more time with patients, you can't deny that a resource-poor hospital with no support staff and an open ICU adds a lot of unnecessary pain and opportunity cost.
Bottom line - top tier program with amazing training, but you can get comparable operative skills with a lot more time for academic pursuits and a lot less suffering at other places.
USC resident here. Some thoughts to counter these points - you can't learn to operate as an attending for the first time (or at least I think most people would agree that they want to be well trained leaving residency and not have to rely on fellowship to learn what they should've learned the past 7 years). So its good to be operatively busy as a resident is a strength. It is true there are other places that can train you comparably with more academic time, but not many.
USC has a few months during PGY4 and PGY5 year (4 months on gamma knife as PGY4, 4 months research as PGY5) to lay the ground work for a PGY6 R25 year (if desired) which is plenty of time to be successful. By this point you have a career trajectory in mind (usually) so you aren't waisting your time doing glioma lab research as a PGY2 research year to ultimately want to be a spine surgeon.
County call is q4, not q3. That makes a big difference. Keck call is more like q5 home call (can still get slammed, the 'home' part can be misleading). Also I wouldn't refer to us as a resource poor program. We are not Barrow/Mayo where there is more money than you can spend. But we have PAs/NPs that help with lots of 'scut', and aren't drowned with mountains of paper work. I would say we are average with resources. Keck ICU is mostly run by neurocritical care, County is mostly by NSG. We work as a team in both places. We also have Pulm Crit care around. It is not a helpless intern trying to experiment and figure it out, we have help. As for teaching didactics, its not as often as other places and I do think its certainly fair to say theres not a lot of spoon-feeding.
USC has a long history of pumping out academic neurosurgeons, as the majority of the grads do go into academic careers. Many are in high level positions are reputable programs across the country right now, and that has its perks when its fellowship time. Several of their residents who are academically minded find time to pump out lots of publications (50+). The above poster is correct however, it is usually required to make a larger effort on the resident's part during postcall/quiet call nights. Admittedly, those are usually clinical papers and not Cell/Nature papers, but very few programs are having residents publish in those journals, certainly none in the 'operative heavy' category.
Ultimately I think the above posts are both correct and make good points. But we find time to have a life outside of neurosurgery, we certainly do get time out to enjoy LA, and we are a happy and cohesive group. We are most likely among the busier programs out there, and the autonomy people talk about I agree we are certainly on a far end of the spectrum but it has never been unsafe. We have the foundation to get you an academic career if that is what you're looking for. We try to minimize the pains of a busy program as much as possible, but residency is pain at the end of the day. Come spend some time with us if you want to see for yourself.
Great post. Always nice to have a current resident’s perspective. Do you have any insight into what the match process will look like at USC? There have been suggestions that programs will lean toward taking their own this year. Do non-USC students still have a shot or are your own applicants have a significant leg up? What can students do to stand out without being able to rotate there this year?
Can anyone speak to the Midwest programs? Specifically, WUSTL?
(05-24-2020, 01:13 AM)Guest Wrote: Can anyone speak to the Midwest programs? Specifically, WUSTL?
WUSTL- only interviewed there, but I thought of it as almost a diet UCSF in a midwest city. Not the biggest fan of St. Louis but it does have some culture, good bars/sports teams. They have a great balance of research and volume, attendings can be tough on residents and arent the super easy going type like at a Michigan or other midwest programs. Great program to train at. Zipfel seems like a great guy, someone I'd enjoy working for.
Enough has been said about Michigan and the Cleveland programs so I'll skip them.
Indiana- hard to say after the split with Goodman, but when i saw it I was most impressed with the spine experience. PGY-2s and even interns were in the OR a lot. Functioned like a private practice with an abundance of routine ACDFs, lamis, microdiscs, etc so from that stand point it's great. Skull base seemed somewhat lacking, Gadol has 1-2 fellows at all times which take up his volume it seems. Endovascular is ran by IR there so it hurts the overall vascular experience. Hard to say what Timmons will do and how the split will affect them but overall it has the foundation to be a great, high volume program that I think will only get better.
Wisco- great chair and program director. Madison is an awesome town. Average volume, average research. Overall solid, in my opinion nothing made it stand out compared to other programs besides the quality of the leadership. Would not have minded spending 7 years there though.
(05-25-2020, 08:45 AM)Guest Wrote: (05-24-2020, 01:13 AM)Guest Wrote: Can anyone speak to the Midwest programs? Specifically, WUSTL?
WUSTL- only interviewed there, but I thought of it as almost a diet UCSF in a midwest city. Not the biggest fan of St. Louis but it does have some culture, good bars/sports teams. They have a great balance of research and volume, attendings can be tough on residents and arent the super easy going type like at a Michigan or other midwest programs. Great program to train at. Zipfel seems like a great guy, someone I'd enjoy working for.
Enough has been said about Michigan and the Cleveland programs so I'll skip them.
Indiana- hard to say after the split with Goodman, but when i saw it I was most impressed with the spine experience. PGY-2s and even interns were in the OR a lot. Functioned like a private practice with an abundance of routine ACDFs, lamis, microdiscs, etc so from that stand point it's great. Skull base seemed somewhat lacking, Gadol has 1-2 fellows at all times which take up his volume it seems. Endovascular is ran by IR there so it hurts the overall vascular experience. Hard to say what Timmons will do and how the split will affect them but overall it has the foundation to be a great, high volume program that I think will only get better.
Wisco- great chair and program director. Madison is an awesome town. Average volume, average research. Overall solid, in my opinion nothing made it stand out compared to other programs besides the quality of the leadership. Would not have minded spending 7 years there though.
This is a great writeup. I can add a little bit as well since I rotated and interviewed at a number of midwest programs.
-Mayo Rochester: This was my favorite program (I rotated but unfortunately did not match here). Overall, this is the Midwest counterpart to the Barrow. Lots of big names: Fred Meyer, Spinner, Link, Lanzino, Bydon, and others. Residents solely focused on operating and taking care of the patients that their consultants carry. Most of the pain that comes with high-volume training is eliminated here - they have foley/IV/transport teams that set everything up, surgical assistants who help with positioning, prepping, and draping, a dedicated imaging service that makes sure all the scans get done, etc. Amazing autonomy in the OR but in a peaceful atmosphere without any malignancy or infighting. 2 years for research or enfolded CAST fellowship where they'll pay for you to go elsewhere if you want. Great brain tumor research (both peds and adult). Loved it here.
-Wash U: Really well balanced program (as the poster above said, similar to UCSF in that regard). Lots of heavy hitters in basic science - tons of R01 grants in the department but also with lots of cases. Attendings were much more hands on than at Mayo but residents get an amazing Ireland experience where they basically run the show and only consult with attendings over the phone (I think only 1 resident has ever declined to go over there). Lots of big names here as well. Classic university setup but they were considering switching from night float to Q5 call. Really great vascular research opportunities (can likely get 1 year of endo done before graduating).
-Cleveland Clinic: Awesome group of residents. Amazing spine and functional experience (have a lot of fellows but tons of cases for just residents). Also have 2 years of fully protected research time where you can go anywhere, but I think enfolded fellowships are now discouraged. PA support for in house night float every night of the week. Really nice faculty.
(05-23-2020, 01:17 PM)amygdala_830 Wrote: Can anyone speak to the north east programs that aren't the "big name" places typically talked about here? Dartmouth, Tufts, BID, Yale, Sinai, Einstein, etc? Do these suffer from being in a compact area or near the NYC/BWH/MGH programs? Which have better research, autonomy, operative experiences, etc?
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