USC vs Utah

[Focus]

I disagree. Trauma cases are phenomenal learning cases for all levels. There is a lot of nuance to it, especially in penetrating and spine trauma.

[Guest]

I respectfully disagree. There's certainly nuance (moreso in spine trauma), but it's really as basic as neurosurgery gets. Cut skin, get down to bone. Drill a few burr holes, turn a crani, slice open the dura (doesn't even matter if you blow through it), evacuate clot, place a drain and close galea. There's a reason they let med students drill burr holes during these cases - your odds of hurting anything are minimal.

The reality is that this doesn't even begin to scratch the surface of cranial neurosurgery. Can you divide the meningo-orbital band and do a Dolenc? Can you split the fissure, in to out? Can you do an OZ? Can you clip an aneurysm through an LSO? Can you find CN7 at the brainstem on a hemifacial spasm case and free it up with fine arachnoid dissection/mobilization? Can you properly set up a supracerebellar infratentorial and not completely beat up the cerebellum and stir up a ton of bleeding from the venous attachments? Can you do a middle fossa approach to an acoustic? Heck, can you do a nice retrosig for a large acoustic? Can you do a telovelar to a 4th ventricular tumor and not beat up the uvula or any CNs? If someone is a chief resident and answers no to any of these, then that's a gap in training.

There is A LOT to learn. Of course most folks will do a fellowship, but if you're stuck doing hemicranis and EVDs until your PGY-6 year (and a lot of these trauma heavy places do) then I really believe it takes away from what actually matters in neurosurgery.

[Guest]

I disagree with the above poster. At these “trauma heavy” places, it’s not an either/or for trauma cases versus these index cases. They’re doing both. Trauma are extra cases. I believe trauma can teach you a lot, it’s not just another cookie cutter hemicrani every time. The reality is, lots of traumas are picked up in trauma rooms, not really bumping the elective ORs which are your deformity spines/skull base tumors/aneurysms or whatever. Usually that gives you a chance to operate in your earlier PGY years to a more substantial hands on degree. But I think it’s a huge flaw to say these programs that deal with a lot of trauma forego the boutique high subspecialozed experience, they don’t; they get both.

[Guest]

To the poster above who dissects CN7 at the stem as a PGY7 chief with no gaps in their training, Can you dissect a poop out of a butthole without making it pucker?

[Guest]

That’s an unfair question, obviously that’s fellowship level stuff

[Guest]

Maybe that's possible, but from my own experience (admittedly a while back): I rotated at the BNI (elective, high-complexity place) and Baylor (lots of call at many hospitals, major county trauma center). The Baylor residents were perpetually overwhelmed. The juniors were forced to leave the ORs to go handle some medically sick, non-op disaster. The seniors were also getting crushed, and a lot of the high level cases were snatched up by fellows. The BNI mid-level residents were more skilled than the Baylor chiefs, because they were able to pick up these advanced skills earlier. Maybe there's a unicorn program out there with tons of trauma and this amazing complex cranial experience, but I'm not aware of one, and I'd take the complex, operate earlier one every time.

[Focus]

Other than decompressing CN7 and taking out a tumor I've performed all of those maneuvers on traumas. At the high volume centers you see the non-cookie cutter acute subdural/hemicrani cases. Ultimately, if you treat trauma like it doesn't matter and that it requires no skill then your outcomes will reflect that. And agree with the other posters, trauma is the godsend for the bored consult resident. The day goes a lot faster when you pop a top or two between back pain consults.

[Guest]

(01-24-2024, 06:07 PM)Guest Wrote: Maybe there's a unicorn program out there with tons of trauma and this amazing complex cranial experience, but I'm not aware of one, and I'd take the complex, operate earlier one every time.

You are describing Emory, but admittedly the Emory trauma rotations at Grady are all as a PGY3 so you aren't covering it your whole residency.

(01-24-2024, 06:09 PM)Focus Wrote: Other than decompressing CN7 and taking out a tumor I've performed all of those maneuvers on traumas. At the high volume centers you see the non-cookie cutter acute subdural/hemicrani cases. Ultimately, if you treat trauma like it doesn't matter and that it requires no skill then your outcomes will reflect that. And agree with the other posters, trauma is the godsend for the bored consult resident. The day goes a lot faster when you pop a top or two between back pain consults.

Agree here, doing complex traumatic skullbase CSF leak repairs and frontal sinus exenterations and the subsequent complex reconstructions and cranioplasties are excellent training for almost any type of cranial approach.

[Guest]

Yes I can. I can show you how to do it too. You can retract the hair for me.

[Guest]

(01-24-2024, 06:07 PM)Guest Wrote: Maybe that's possible, but from my own experience (admittedly a while back): I rotated at the BNI (elective, high-complexity place) and Baylor (lots of call at many hospitals, major county trauma center). The Baylor residents were perpetually overwhelmed. The juniors were forced to leave the ORs to go handle some medically sick, non-op disaster. The seniors were also getting crushed, and a lot of the high level cases were snatched up by fellows. The BNI mid-level residents were more skilled than the Baylor chiefs, because they were able to pick up these advanced skills earlier. Maybe there's a unicorn program out there with tons of trauma and this amazing complex cranial experience, but I'm not aware of one, and I'd take the complex, operate earlier one every time.

Second this. Rotated at Baylor a couple years ago. Residents are always slammed don't get the opportunity to take on higher complexity cases because of it. The issue lies with the PD and chair for running the program like it's still the 70's instead of using the TMC's resources to support their residents like BNI does.