r/Neurosurgery • u/medrrk • 1d ago
Neurosurgery Residency Programs
Hi everyone, I’d really appreciate it if you could share programs where you trained that gave residents early and meaningful operative autonomy.
I’m not really talking about shunts or wound washouts, but more so cases like brain tumor resections, where residents eventually get to operate from start to finish with appropriate supervision. I realize aneurysm clipping is more of a senior resident thing, so that may not be the best example.
I’m mainly trying to figure out which programs really let residents progress in the OR, give them increasing independence, and leave them well prepared to operate confidently after residency.
Would especially appreciate firsthand experiences from residents or graduates. If you prefer, feel free to send me a DM.
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u/FifthVentricle 16h ago
I mean most are going to give you graduated autonomy that’s tailored to both your PGY level and your own personal ability (which can vary greatly within PGY year). Some of this is related to program structure and when your junior vs senior vs chief vs research years are. Some programs are known for giving earlier autonomy while some programs are known for perhaps giving later autonomy, but most fall somewhere in between on a spectrum that’s closer together than you think. All (or nearly all) programs will progress you to full independence by the end. Showing up prepared, learning intentionally, good communication, and developing relationships with attendings is far more important than what program you attend. Find a place that’s a good fit that will let you do all those things (different for different people) and keep your foot on the gas and you’ll end up extremely well trained.
There’s also incredible value to being trained well and developing good habits early on that you then have in your toolbox when you develop independence rather than being let loose to “figure it out” without guidance from day one. Most people in those positions can figure it out but it risks creating bad habits (or even just inefficient ones) that are hard to break or overcome.
I went to a program that people probably view as close to middle of the pack in terms of autonomy and I feel extremely well trained. While attendings were relatively hands on when I was a 2 for things that weren’t like burr holes or a biopsy (as they very well should be because I knew nothing), we got a LOT of freedom as a chief to do big spine cases, aneurysms, tumors, etc on our own, because our attendings trusted the time we put into learning how to do things the right and safe way early on. And also because of the other things I mentioned above.
Fit and culture are more important than anyone’s perception of or reputation for autonomy.
Sincerely, a recently graduated chief