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Carolinas Medical Center
#1
I wanted to leave a review of my Sub-I experience at Carolinas Medical Center (CMC) because I was really impressed by this place and since it is a newer program, less is known about the Sub-I experience on this website for future applicants.

Background of program



This a well-respected private practice group called Carolinas Neurosurgery and Spine Associates (CNSA) that covers many hospitals in the Charlotte, NC area. Their mothership is Carolinas Medical Center (CMC) which is a large 874 bed Level 1 trauma center and the entire neurosurgery residency responsibilities are focused at this one hospital and the outpatient surgery center across the street. There are 34+ neurosurgeons in the practice, but only ~17 operate at CMC. The residency program just started 2 years ago so they only have 2 residents currently, but the CNSA group has been around for over 75 years so this is only a new program in regards to its residency.  They have a full mid-level PA, NP staff that helps with floor work and call.

Operative experience



They usually run about 6-7? ORs each day. There are only 2 residents at this program, so therefore there are many cases that are not being covered by a resident. There is also only one rotator at a time so you just pick whatever cases you want to go to each morning and can hop from room to room during the day to scrub the best cases. Most attendings have a PA operating with them but if you find the room ahead of time the PA will either not scrub in or break scrub early if you are able to assist appropriately. I could reliably expect to be allowed to be the observer under the microscope for cranial cases and spinal cases where it was used. I also was consistently invited to help with closing. If you prove you are able tie knots proficiently and suture well, I think you are extended many more opportunities. From the cranial aspect, I was given the opportunity to drill burr holes, turn the bone flap, dural tackups, dural incision, dural closure, replacing bone flap, and scalp closure during one time or another. There were a few times where I was allowed to assist with instruments/retraction/suction under the scope for less complicated procedures. From the spine aspect, I was afforded opportunities to help with exposure, rongeur the lamina, screw in pedicle screws (with attending guidance obviously), and help with closure of fascia, subcu, and dermis. Many times you are being taught directly by an attending which is an incredible learning experience probably not consistently available anywhere else. You will also get to scrub many cases with the intern and second year residents for subdurals, epidurals, and simple spine cases they are scrubbing on their own. They are also great teachers and you are able to learn a lot from them.

Routine



I would usually get to the hospital around 5:45 to pre-round and write notes on post-op patients for cases I scrubbed the day before. Pre-rounding was usually wrapped up by 6:30 and then we would meet with the attendings and PAs for table rounding and looking at imaging. Depending on the attending, some liked to round bedside. As a sub-I, your responsibility was just to go to the OR once cases start, usually around 7:30 or 8. During the day, I would just try to scrub as many cases as I could until the ORs were done running, typically 3-4 cases per day depending on their length. Most days this wasn’t much later than 5 or 6 pm but some days there were cases that were running later into the evening. The second year resident takes q4 call and so you usually take call with them a few times during the month. You usually come in and work one day per weekend and if there is nothing operative once rounding and floor work is taken care of you can leave.



Letters



Dr. Asher is the program chair. He is a former CNS president and very well-connected. I think as far as name power his letter can take you far. Dr. Wait is the program director. He is a younger BNI grad so a letter from him may not be as powerful yet at programs with older chairmen who may not know him as well. He is very well remembered at Barrow and a positive letter will take you far there.

Dr. Wait is a great attending to work with as he is very passionate about bringing his barrow teaching philosophy to the program and is very involving with you in the operating room. All of the attendings I met were extremely nice, friendly, and inclusive of you as a sub-I. 

Residents



The two residents there are both really great guys. Very normal, well-rounded, and down-to-Earth people. Also very smart, efficient, and technically proficient in the ORs. They are two of the happiest neurosurgery residents that I met on my Sub-Is or on the interview trails. They invite you to many social events and give you opportunities to hang out with them outside of the hospital.



Perks



You are given a food allowance and the cafeteria is the best that I have seen. There is also an awesome surgeons lounge that always has sodas, drinks, salads, sandwiches, soup, cereal, coffee, ice cream sandwiches and other snacks that are always available. There is also a med student gym in the hospital that I never used if you’re into that. Charlotte is a great city with warm weather when you have days off.



Downsides

If you are looking for a sub-I with operative experience, there really are not many down-sides to this program in that regard. If you are looking to rotate at a place solely for the letter to get you into UCSF or Hopkins this is probably not the sub-I for you, but I think after a month at Carolinas you will stand out in the OR at other aways from what is expected of a sub-I. Other programs may offer better didactic teaching sessions where you may learn more from getting pimped heavily, but ultimately this is determined by how much you read on your own. Since there are only 2 residents and it is a private practice, the teaching conferences with the residents are less frequent. That being said, when they do occur it is a pretty great experience because there are usually more attendings than residents at these conferences so the teaching perspectives are great.



Logistics



To apply to this Sub-I you have to go through the UNC VSAS application. All the information is available on the CMC website here: www.carolinashealthcare.org/default_physicianpractice.cfm?id=16428


For any future applicants that have any other questions I didn’t answer feel free to email me at vrossi89@gmail.com. I would be happy to share my case logs from my sub-Is showing which cases I scrubbed in on at Carolinas, Barrow, and Tennessee (all fantastic operative programs in my opinion).
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