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Applicants, what are you looking for?
#1
I’m a resident at an east coast program. I think attendings and programs have many ideas on what they think applicants are looking for in a program, but some of these ideas may be outdated. Why not ask you. What is the 2022 Neurosurgery applicant looking for in a program?
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#2
Graded autonomy, increased operative experience, less focus on less educational scut, a collegial atmosphere where all residents get along, no history of firing (firing is usually a weakness of a program instead of a person), good network of graduates. Really looking to become a family, you’ll be with them the next 7 years of your life!
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#3
I sincerely hope your family is better than what your co-residents and attendings will be. Don't look for a family, look for great colleagues and you will not be disappointed. There is a big difference.
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#4
(08-06-2021, 06:10 PM)Guest Wrote: Graded autonomy, increased operative experience, less focus on less educational scut, a collegial atmosphere where all residents get along, no history of firing (firing is usually a weakness of a program instead of a person), good network of graduates.  Really looking to become a family, you’ll be with them the next 7 years of your life!

I disagree with your point on firing. The rate of attrition is high in neurosurgery for a reason, residency is not easy. Matching into neurosurgery is not a guaranteed ticket to becoming a neurosurgeon, nor should it be. You still have to perform, and there are people who are unable to do that and if allowed to graduate will hurt patients.

In my opinion it takes great courage for a program to fire a resident they believe is dangerous. Firing opens a program up to all sorts of criticism from applicants, colleagues, and the ACGME, and also opens them up to lawsuits. Just look at WashU, people already questioning a top notch program on this site for this. It takes leadership to make that decision with confidence and take the backlash.

Now what you should look out for are the firing of multiple residents in a short period of time, or a higher rate of attrition than normal. Also, you should ask what was done for these residents. Were they warned once then fired out of the blue? Did they go through a remediation period with counseling, 1 on 1 mentorship with program leadership, and then were fired? You should make sure they weren't let go on a whim or simply because they weren't liked.
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#5
At the same time there are dangerous residents that are graduated every year. I have seen it so many times. We work with dangerous attendings all the time. Neurosurgery is a dangerous specialty. If you have spent anytime on a neurosurgery service you will know that there are patients on the service at any given time that were harmed by the residents or attendings. It’s a fact and these bad outcomes get swept under the rug. It’s one big lie. Bad outcomes get chalked up to it was a bad disease and the patient is going to die anyway vs a bad surgery. Nice, well liked people will often get passed along even if they are below average surgeons.

Agree 100% firing a resident is not easy but it needs to be done.
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#6
(08-08-2021, 04:25 PM)Guest Wrote:
(08-06-2021, 06:10 PM)Guest Wrote: Graded autonomy, increased operative experience, less focus on less educational scut, a collegial atmosphere where all residents get along, no history of firing (firing is usually a weakness of a program instead of a person), good network of graduates.  Really looking to become a family, you’ll be with them the next 7 years of your life!

I disagree with your point on firing. The rate of attrition is high in neurosurgery for a reason, residency is not easy. Matching into neurosurgery is not a guaranteed ticket to becoming a neurosurgeon, nor should it be. You still have to perform, and there are people who are unable to do that and if allowed to graduate will hurt patients.

In my opinion it takes great courage for a program to fire a resident they believe is dangerous. Firing opens a program up to all sorts of criticism from applicants, colleagues, and the ACGME, and also opens them up to lawsuits. Just look at WashU, people already questioning a top notch program on this site for this. It takes leadership to make that decision with confidence and take the backlash.

Now what you should look out for are the firing of multiple residents in a short period of time, or a higher rate of attrition than normal. Also, you should ask what was done for these residents. Were they warned once then fired out of the blue? Did they go through a remediation period with counseling, 1 on 1 mentorship with program leadership, and then were fired? You should make sure they weren't let go on a whim or simply because they weren't liked.

No one who has been fired after going through all that is going to admit that they had multiple chances and still fucked it up. They’re always going to spin it like it wasn’t their fault. In a field full of the elite no one ants to admit that they were the sub par or dangerous one.
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#7
It's quite hard to fire a resident. Usually one has several meetings/warnings before being put on probation or getting the axe.
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#8
Agree with the above poster. The fact that a resident has been fired from a program is not a metric by which to judge a program. These programs have a dual responsibility, to guide and educate residents, but also to protect the public that these residents will serve. If it becomes clear that even with remediation and extra time/attention a resident will be a danger to his future patients, the program has obligation to terminate that resident. They would be remiss in their responsibilities if they did not.

As the above poster accurately stated, a single resident firing is not a red flag, particularly in the junior resident complement. It’s multiple residents within a few years, or the firing of senior residents, that is more of a red flag.

From personal experience, I trained at a program that fired a junior resident. They were NOT happy about it. He was given literally YEARS of extra opportunities to prove himself up to the task of neurosurgery training, and continually failed to make improvements. He eventually found a spot in another surgical specialty, and years later I found out that he was fired from there as well. Some people are simply not able to be surgeons
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#9
Honestly, take a look at your attendings. Some are great and some are aweful. They are Attendings most likely in academics. You know what they say…”those that can’t teach”. Prove me wrong. Many would not be able to cut it in private practice they are to inefficient and incompetent or WEIRD or RUDE or AUTISTIC.

Additionally neurosurgery does not recruit “the best”. The absolute cream of the crop due not go into neurosurgery. Most medical students are to talented and smart for neurosurgery. . In fact really talented people go into any specialty but neurosurgery.

Neurosurgery tends to recruit people who are insecure overachievers. They somehow think that by being a neurosurgeon that they will fill in all of their deficiencies. Lots of personality disorders in neurosurgeons. You do see this as much in orthopedics who recruit a bunch of jocks that play team sports. Most neurosurgeons would never be accepted by the orthopedics community for example. Most orthopedics would never fit into neurosurgery. Neurosurgeons are WEIRD in general.

Some of the most dysfunctional doctors/people that I have ever met were neurosurgeons. They go on to have disfunctional personal lives with multiple marriages and their kids are all jacked up.

Real men and women do anything but neurosurgery.
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#10
(08-08-2021, 08:03 PM)Guest Wrote: Agree with the above poster. The fact that a resident has been fired from a program is not a metric by which to judge a program. These programs have a dual responsibility, to guide and educate residents, but also to protect the public that these residents will serve. If it becomes clear that even with remediation and extra time/attention a resident will be a danger to his future patients, the program has obligation to terminate that resident. They would be remiss in their responsibilities if they did not.

As the above poster accurately stated, a single resident firing is not a red flag, particularly in the junior resident complement. It’s multiple residents within a few years, or the firing of senior residents, that is more of a red flag.

From personal experience, I trained at a program that fired a junior resident. They were NOT happy about it. He was given literally YEARS of extra opportunities to prove himself up to the task of neurosurgery training, and continually failed to make improvements. He eventually found a spot in another surgical specialty, and years later I found out that he was fired from there as well. Some people are simply not able to be surgeons

Agree 100%. There is so much oversight that gone are the days when the chair could fire you on a whim. You would be shocked to see the stuff that gets swept under the rug, goes to remediation, "medical leave" and etc... 

Now every time we discuss the topic, Chris Duntsch is going to come up. Attorneys are now going after his PD and chair for damages, it is their worst nightmare.
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