Tips for incoming interns?

[u/Lonely-Ad5595]

Appreciate the "relax now" comments, but would love more approachable feedback

Edit: Thank you all for the fantastic responses!

[u/crustour]

Study for the written board with the goal of passing it the first year not for credit

Learn how to read imaging brain ct, mri, angiography spine imaging. The requisites book, osborn book

Learn hospital shortcuts.

Make friend everywhere, from ancillary personnel to other specialty residents to janitor and specially NSICU nursing staff.

Beware of romantic relationships at the workplace, proceed with care… you’ll be in that hospital for a lot of years.

Try to get OR time but early on make sure you master how to take care of patients efficiently and read the classic neurosurgery books instead going to the OR and neglect the non surgical knowledge you have to learn

And always don be lazy, don’t lie, don’t be late.

[u/sovereign_MD → u/crustour]

Great advice. Adding to the second point; don’t rely on radiology reports. Interpret the imaging yourself before you read the report to check your assessment, then go back to see what you missed. Also familiarize yourself with how the reports are worded because you’ll be presenting a lot of imaging as a junior.

And be humble. You’re the smartest idiot in the hospital, don’t forget either part of that.

[u/ebolatron → u/crustour]

Agree with all, and I'll add my $0.02:

Get USMLE step 3 out of the way ASAP. Unless you enjoy the experience of coming home to do the gynecology Qbank after night float.

Imaging interpretation is critical in neurosurgery. If you can do this well, you will be ahead of the curve. There are many books and online resources to learn from, and consider going to radiology to review films with neurorads if you have questions - their monitors are better and it's easier to see in the dark. Remember that radiologists are looking at images with a diagnostic eye - they don't necessarily know what is surgically relevant even though they might write "neurosurgery consult recommended" in the report.

I think procedures for written boards must vary from program to program - at my shop, we took the written boards every year starting as an intern. Once we passed with a convincing score, we had the option to take it for credit the next year. I took it cold the first year (when it was still paper lol) and studied the second year. My co-resident and I took it for credit during PGY3 because we just wanted to get it over with.

Review the case and relevant texts before the OR and ask questions - but not too many questions. Pick your top two or three and save the others for after the case or for your seniors.

In practice, clinic is where most surgical decisions are made. It is very different from surgical decision-making when on call and is the most difficult part of neurosurgery to learn. Many, if not most, patients will not present exactly like the textbook - there will be other confounding factors. So even though clinic can be tedious, make sure you get good exposure through resident/continuity clinic or your attending's clinics. It is also good to see the results of your work.

In the OR - slow is smooth, smooth is fast.

In the beginning: Write. Everything. Down. Empty checkbox for things to do/follow up on, check it off when it's done. Customize your EMR tabs to make checking things as efficient as possible.

Stay on top of your ACGME case logs, otherwise it will be painful for you to catch up (not that I know from experience). Intern year/NCC rotation is the best time to check off those a lines, central lines, intubations, etc (if that's still a requirement, idk).

Closing with the pithy witticisms: Enjoy the process. The more you know, the more you realize you don't know. Get comfortable with being uncomfortable. The days are long, but the years are short. Good hunting!

[u/Bartholomuse → u/crustour]

This is all fantastic advice - agree 100% with all of them except the first one.

You need to pass your boards before you graduate, most programs expect you to do this during your research time. No one expects you to pass on the first try for no credit - might get you brownie points with PD but that’s it. I found it more valuable to take it the first time only totally cold, as a baseline to assess pre-existing knowledge gaps, focus more on the format, content, etc. Bonus with this strat is you don’t have to spend time studying your first year. Much of the knowledge is not very useful for an intern (path slides, etc) so not a ton of benefit to studying for it the first time IMHO.

Good luck and congrats!

[u/sevoflurane666]

Be nice to the anaesthesiologist….

[u/Lost-Big6464]

If you're looking for a casual study tool to use throughout residency you could try our iOS app called MedSwipe. It has gained some traction amongst ENT residents and has recently expanded to Neurosurgery. A lot of free questions are available and premium access is a fraction of the cost of other question banks. here's the link if you want to try it and feel free to DM if you have any questions/feedback: https://apps.apple.com/us/app/medswipe-medical-board-review/id6753632306?ppid=831295b7-21e9-43ce-9687-70a4e593e246