How do people feel about intern year being a key year in terms of holding the pager during the day? I’ve heard of some programs that throw interns right into it versus the traditional hand holding type of method where you don’t bear much responsibility until PGY2. Potentially frees up juniors to operate instead of dealing with the consults/floor stuff during the day. Programs that are like this off the top of my head are CCF, Northwestern, Vandy. Any other perspectives on this?
Don't get the point of putting it off till 2nd year. You gotta learn it sometime, so might as well get it over with as soon as possible and get down to doing actual neurosurgery.
If you spend all your intern year just managing floor patients or doing off-service rotations, then you'll be a whole year behind compared to other programs.
And yes, the sooner the interns are holding the the pager, the more it takes that off the other juniors, allowing them to operate more undisturbed.
What the hell are interns doing at these programs if they're not supposed to hold the pager?
I really don’t know. I think the quality of intern really varies by program. Maybe stronger programs can get away with interns holding more responsibility.
So if you don’t hold the pager as an intern when will you learn consults, preop and postop care. Programs having the intern hold the pager are setting them up for a fruitful PGY2. You may get to go the OR some as an intern but when you do more as a PGY2, you learn the full circle of care. I’d hate to have a stagnant intern year, you’ve waited all this time to be a neurosurgeon, jump into the fire
Like anything else, graded responsibility is key. I would consider it a red flag if you get all the way thru intern year and don't even spend a few days holding the pager on a neurosurgery service.
That being said, some program stress neurosurgery experience so much intern year that many enter PGY-2 year fundamentally under-trained in the basics of critical care, general surgery, and basic peri-op medicine. If you can't name the layers of the abdominal wall you damn sure aren't putting in any of my shunts. If you can't figure out if your post-op might be having a PE or MI, you'll probably kill someone at some point.
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I think people are over emphasizing the timing of pager holding. Those off service rotations are mandatory, I'd rather get them over as an interns versus have then disrupt later parts of residency. What I think is more valuable to look at is the structure of the pager holding. I think it's best to do it all in one consecutive block rather than do it in a scattered fashion throughout a year or several years. Easier to climb the learning curve.
The quality of US neurosurgical training has gone down since duty hours and shifting the internship away from general surgery.
