Hey guys;

I just found out about this awesome website. Expect to hear a lot from me

I’m currently a MS3, actually half-way through 3rd year since my school has a weird schedule. I’m wondering at what point people start applying for away 4th year rotations, and how they decide which programs to apply to.

Any advice about this would be really appreciated!

Greetings Afanous! If you apply for 4th year away rotations early next year, you will be well ahead of the game. From memory, the earliest deadlines are April 1, and some don’t let you even apply until May. If your school has a weird schedule, doing sub-I’s at a weird time may be a great way to have access to a less crowded away rotation experience. Deciding what programs to apply to can be a complex process - start by excluding places you would refuse to live, then include a generous range of programs, ideally under the guidance of your chair, tailored to your credentials and personal preferences. You may be able to learn a fair bit about some programs from this website, but many programs largely escape mention. As always, maintain a healthy skepticism about what you read. You may find some of the discussions loosely collected below to be of some assistance. Welcome!

Uncle Harvey’s Guide to Applying for Neurosurgery Residency

I also have a question regarding away rotation selection. If one is interested in a particular geographical region, such as a city (e.g. Boston), would it be wise to do both away rotations in the city (e.g. MGH and BWH), or will that send the wrong message to other programs outside the region? Any advice would be greatly appreciated.

Awesome! Thanks a lot Stem Cell for your response and for the link. I’m still in the process of devouring the wealth of information contained in this website

Now, in the upcoming few months until I begin my 4th year rotations, how should I prepare well for neurosurgery internships? I’ve been reading a lot on this website about people “mastering the Greenberg” handbook; is that realistic? And what else would you do to look good on the wards and in the OR?

Thanks again!

Chloramphenicol: Rotating at MGH and BWH sounds like it is actually expected if you are from Harvard… If you are from somewhere else and want to do BWH and MGH, maybe throw in a 2 week rotation somewhere else to offset any raised eyebrows? I think diversifying geography is generally a reasonable idea if possible but I wouldn’t lose sleep over it - just be able to expound upon your reasoning for seriously considering program X if you have never spent any time in that part of the country.

Afanous: I’m not sure even most residents can reliably quote Greenberg cover to cover - its a pocket REFERENCE - by all means carry it everywhere and read it liberally, but I think Rengachary and Ellenbogen’s “Principles of Neurosurgery” and/or Liebenberg’s “Neurosurgery explained: A basic and essential introduction” may make for more meaningful med student cover-to-cover reading experiences. For rotations, I think neuroimaging and neuroanatomy are the highest yield topics. If you can eloquently answer “what do you see?” with the imaging modality used, the specific anatomical localization and radiological description of the lesion, you will have done extremely well, even before rattling off your differential. As always, know everything about your patients and read up on the procedure for each case. Find out from the resident what you can do to help prepare for a case - pull up the films, prep the Mayfield, position the lights, etc. Know how to tie efficiently with no air-knots. The OR is the place to perform what you learned and practiced at home. Ideally, have one of your residents coach you on closing well (and give you plenty of hands-on) in preparation for your aways. Go the extra mile - eg, for clinic, figure out how to get the schedule ahead of time, then take the time to look up the patients and review their imaging in advance. Make the most of attending face time - have a few relevant and thoughtful questions at the tip of your tongue at all times, but only ask them when the time is right. Above all, be prompt, dependable, and a pleasure to work with, rather than the infamous arrogant, cocky know it all that steals cases from other students. Make your co-students and residents look good whenever possible. Developing a good rapport with your fellow students and residents is essential, and will likely reflect favorably in your letter. Create allies wherever possible, from secretaries to nurses and techs - don’t ever talk down to (or about) anyone. For other thoughts, see chapter 7 in the “UH guide.”

Awesome! Thanks a million stem cell for the advice; again

I just got “Another Day in the Frontal Lobe” by Katrina Firlik. I’m hoping to read it between rotations. I heard it’s enjoyable for aspiring neurosurgeons. Not academic of course, rather a compilation of OR and other stories by a NS. I’ll keep you guys posted about what I think of it.

As always, know everything about your patients and read up on the procedure for each case. Find out from the resident what you can do to help prepare for a case - pull up the films, prep the Mayfield, position the lights, etc. Know how to tie efficiently with no air-knots. The OR is the place to perform what you learned and practiced at home.

Regards

Joyce

____
simulation de pret

if you have any attention of applying to top programs, take step 2 cs and ck early when you remember all the third year material. its good because you can a) mentally checkout and read mostly about neurosurgery and b) some programs have started to require passing both before ranking any applicants.

gs228135 - 03 October 2009 02:35 PM

if you have any attention of applying to top programs, take step 2 cs and ck early when you remember all the third year material. its good because you can a) mentally checkout and read mostly about neurosurgery and b) some programs have started to require passing both before ranking any applicants.

I’ve been hearing that more programs are looking for step 2 scores as well...is the overall consensus still that students who performed well on step 1 can still take step 2 later? thanks in advance…

I think all programs do like to see continued success with the Step 2 numbers.

However, probably only about 50% of applicants actually have these numbers in with their application by the time we review it for our rank lists.

So, in order to make an “apples to apples” comparison—we have generally only compared the Step 1 scores.  Of course, while a excellent step 2 score can help (over 250), generally other scores don’t tend to make a difference either way. 

Just my opinion.

While on the subject of preparing for 4th year, I have a question about sub-I timing. What are the most popular months for 4th years to be on sub-Is? Also, when is the ERAS deadline? Thanks.

h.perowne - 11 November 2009 08:47 PM

While on the subject of preparing for 4th year, I have a question about sub-I timing. What are the most popular months for 4th years to be on sub-Is? Also, when is the ERAS deadline? Thanks.

Most non-MSTP fourth years tend to do their home institution first in July, then their aways in August, September, and/or October. A few have been known to squeeze an away in November, but that’s getting a little late since interviews occur during that month. If you’re MSTP, you may have a little more flexibility to do away rotations earlier than July because your required rotations may have been done in a different or earlier order—this might give you the advantage of being the only away sub-i with more chances to shine.

There is no ERAS “deadline” really, but the first date to submit your ERAS is Sept 1st. This is the earliest date that programs can download your application. Most people submit their application in early to mid-September since it makes you feel better when interviews start rolling in earlier; one PD also told me that earlier is also better because the faculty/residents get (understandably) tired after reading so many apps, so you want to be on the top of the stack while they’re fresh and 100% interested. Most programs have an arbitrary submission deadline by October 31st or so.

If you’re next question is, “How would I submit my ERAS if I’m on an away in September,” then my answer would be: my school had us prepare our CVs and personal statements during the last leg of third year—which is the most time consuming part of the ERAS application. This allowed me to submit my ERAS in early September while I was on my last away.

Hope this helps, and goodluck on the scheduling.

galen - 12 November 2009 08:44 AM

h.perowne - 11 November 2009 08:47 PM

While on the subject of preparing for 4th year, I have a question about sub-I timing. What are the most popular months for 4th years to be on sub-Is? Also, when is the ERAS deadline? Thanks.

Most non-MSTP fourth years tend to do their home institution first in July, then their aways in August, September, and/or October. A few have been known to squeeze an away in November, but that’s getting a little late since interviews occur during that month. If you’re MSTP, you may have a little more flexibility to do away rotations earlier than July because your required rotations may have been done in a different or earlier order—this might give you the advantage of being the only away sub-i with more chances to shine.

There is no ERAS “deadline” really, but the first date to submit your ERAS is Sept 1st. This is the earliest date that programs can download your application. Most people submit their application in early to mid-September since it makes you feel better when interviews start rolling in earlier; one PD also told me that earlier is also better because the faculty/residents get (understandably) tired after reading so many apps, so you want to be on the top of the stack while they’re fresh and 100% interested. Most programs have an arbitrary submission deadline by October 31st or so.

If you’re next question is, “How would I submit my ERAS if I’m on an away in September,” then my answer would be: my school had us prepare our CVs and personal statements during the last leg of third year—which is the most time consuming part of the ERAS application. This allowed me to submit my ERAS in early September while I was on my last away.

Hope this helps, and goodluck on the scheduling.

Really appreciate the advice, Galen.

Another thing I have a question about is Step 2 timing for the individual who is taking a year off between years 3 and 4. If this individual did well on Step 1, is it okay to push Step 2 into late 4th year, although this would mean taking the exam a year after completing core rotations? Or would it be wiser to take it before the year off, even though the individual’s Step 1 score is well above neurosurgical matched average? Thanks a lot.

I might add one opinion to this thread regarding where to schedule your away rotations and when to schedule them.

we see a reasonable number of externs across a ~ 4 month window in the Fall.  The ‘best’ time to be an extern is around Sept/Oct, provided that you don’t need the letters of recommendation from the place where you are auditioning. My reasoning is because the early sub-I’s tend to fade in memory a bit as the year progresses and more sub-I’s rotate through. Certainly one can remember them more than an applicant who interviews w/ you for an hour, but among the other sub-I’s it can be difficult to discern by the time the match lists are due.

If I had to apply again, I would do one on-service NS rotation as an MS4 early in the academic year, then schedule one sub-I at a place in my top 5 desired programs for Aug or Sept, then my TOP pick for Sept or Oct. By then, your NS skill set is well refined, you’re accostumed to the types of questions you’ll be asked, and you’re game is at it’s height. I would avoid heading to your top program prior to doing an on-service rotation at your home institution. Consider your home institution your Spring Training.

Finally, keep in mind that some programs are teeming with sub-I’s. I don’t know the current numbers for each program, but med students flock to NS programs that have excellent medical schools. You may find yourself rotating with 6 other sub-I’s. I would not want to be doing my first NS rotation at my top pick instition with 5 other sub-I’s who have 3 months more experience than you because, like it or not, you will be compared against those peers.

good luck!

Hey all,

First of all, I want to thank you guys and gals for all the insight on this website.  Very useful stuff.

Currently, I’m in a research fellowship year following MSIII, and I am starting to think about sub-I scheduling.  I’m from a middle-of-the road medical school, which doesn’t have an in-house residency program for nsurg.  We do, however, have a clinically busy neurosurgery department.  My original plan was to spend a 4 week elective at my home hospital prior to doing any of my away electives. 

The primary question I have regarding this is if it is better to spend this time doing an elective at an institution where there is a residency program and where I would actually have the option of ranking and matching.  Or is it better to spend the 4 weeks at my home hospital brushing up on my clinical skills after taking a year off, getting a letter from my chairman, and doing 2 additional away electives.

Thanks for your help.

You may actually want to solicit advice from your chairman to see what students have typically done in the past.

There are plenty of current residents from medical schools which didn’t have neurosurgery residency programs at their affiliated hospitals, and they ended up doing 3 away electives and getting letters from those 3.  If you actually have a neurosurgery department (but not a residency program) at your hospital, that may be a bit more tricky. Courtesy may demand that you rotate through your own department first; schools may raise an eyebrow at your application if you don’t have a letter from your home chairman. Or, your school may be known for students not doing rotations at its home department and doing 3 completely away electives.

So again, it may be best to ask your home chairman to see what other students have done in the past. If you have access to other friends who have gone into neurosurgery (senior students or younger residents around the country), you can always try them too. Best of luck.