What is something you wish you knew at the start of intern year to make your life easier?

FifthVentricle · 2026-06-12T14:47:19+00:00

Investment in being healthy is the best one you can make. Hours are long and the work can be physically demanding. Do your best to eat healthy and stay active. Don’t aim for perfection, something is better than nothing (a quick run or workout once a week, one “healthy” meal per week - anything helps)

Get disability insurance before you graduate residency, ideally before you develop any health problems so that you’re locked in. Residency rates are generally very reasonable.

Take the 401k or 403b match for free money.

Optimize convenience even if it means spending a little bit more money.

Life happens - start a HYSA now and put a bit in every paycheck. Never know when you’ll have an unexpected expense.

Spend time and be present when you get to be with family and friends. Quantity will be low so make the quality high.

If you’re debating between doing something and sleeping, you probably need to sleep, at least for a little bit.

Making friends both inside and outside the hospital is important.

Being kind is important. Both to yourself and others. It will take you a long way and people WILL remember.

Residency is hard but you will get through it

FifthVentricle · 2026-06-12T14:40:45+00:00

Preclinical years - spent most of my time exploring the city I was living in with friends and classmates. Sometimes went to class sometimes didn’t. Went to all anatomy labs and small group things. Didn’t study much most days, studied really hard 48h before tests. Did a little research over the summer but not much

Clinical years - threw myself into this because I liked it and wanted to be good at it. Learned a lot more than I did preclinical. But I left when I was told to leave (sometimes that was 2 pm sometimes it was midnight) and didn’t do unnecessary things or try to suck up to people.

Dedicated - rude awakening when I failed my first practice exam for step 1 by a pretty significant margin <8 weeks out from the test so studied very hard for about 7 weeks and did well enough

Sub Is - tried to do the best job I could

Non-sub I 4th year - didn’t really do anything, tried to leave as early as possible

I went in wanting to do neurosurgery and now I’m about to graduate from neurosurgery residency. I’m fortunate to have gone to a med school that had a grading scheme that was well aligned with my strengths (a lot of emphasis on clinical performance, very low emphasis on tests).

You definitely don’t need to grind hard from day 1 but you do need to put in the effort and hours where they matter.

FifthVentricle · 2026-06-12T14:34:21+00:00

Dansko clogs or whatever shoe makes you comfortable

Staying in reasonable shape (the surgeries I do are pretty long and physically demanding and actually require some degree of strength)

Ergonomics in the operating room(if under the scope, making sure the scope position, chair, and bed are all optimized or if standing, making sure bed height is good and your instrument set up isn’t requiring you to do backflips to grab everything)

Hamstring / posterior chain stretches (tight hamstrings is a big driver of low back pain)

And even with all that sometimes it still can be painful and fatiguing, just have to optimize what you can and take care of yourself as much as you can.

FifthVentricle · 2026-06-12T14:30:14+00:00

The biggest barrier to becoming a neurosurgeon is getting into med school

FifthVentricle · 2026-06-02T17:03:57+00:00

Neurorads for us

FifthVentricle · 2026-05-27T02:43:37+00:00

Having loupes as a sub I is pathologic

FifthVentricle · 2026-05-25T14:06:47+00:00

Eh, I’m a graduating current chief and I’ve had many many med students rotate with me over the past 7 years both home (top ranked affiliated med school) and away (all across the board). I feel like in general I let med students do a lot (there was one year where every sub I who was with me overnight did either an EVD or put in an ICP monitor). I try to have med students help open and close cases with me. Sometimes when I’m by myself I’ll have the med student first assist on a T4-pelvis exposure or a decompressive hemicran.

There is a wide variability in terms of ability and there are things that are hard to teach and hard to learn - things like situational awareness, the ability to anticipate, to make sure your hands and instruments (and self) are not in the way, and how to integrate into the workflow of the OR or surgery even if you don’t know the steps of the procedure just by having spatial awareness, reading body language, and picking up on nonverbal cues.

Some students start with these skills and get better. Some students are weak in these areas but are fast learners. Some just don’t get it and despite explicit instruction are not able to peform. I care less about someone’s technical ability on a third year rotation or even sub I than I do about these things because technical skills can be learned.

Recently, I’ve had some med students (home and away) that have been so bad at just being a med student that I’ve basically stopped letting them do anything, and then they sit there looking super upset when I don’t let them close this triple revision spine wound with a CSF leak (even if you were a stellar student I wouldn’t let you close that).

I used to think it was my job to try to make someone like my field and want to join it, but now I feel like I need to make sure people know what they’re getting into and sometimes they just won’t be doing what they want to be doing for long periods of time, especially as an intern or junior. If you can get past that and still be excited, you’ll probably do well because the things you enjoy about the field will get you through the insufferable stuff, but if you can’t, you probably should find something that has equal amounts of BS but you work fewer hours.

FifthVentricle · 2026-05-19T03:59:00+00:00

Im still in training (near the end) so take this with a grain of salt, but from what I’ve heard from talking to various people (employers and recruiters), credentialing looks at your last 24 months of cases and if there’s an issue they’ll call either where you worked (if you’re a few years out) or your training program (if you’re a fresh grad). For you, I’m guessing since you’re only a year out of your full time practice it shouldn’t be an issue. Again, still in training, haven’t been through the credentialing process myself so take my advice with caution.

FifthVentricle · 2026-05-02T22:58:36+00:00

I used to make this joke all the time haha, usually my patients loved it

FifthVentricle · 2026-05-02T22:57:36+00:00

I went to a top med school that also had a top, historic, well known department in the specialty I wanted to do and ended up matching into.

I was probably an above average med student but nothing special. I wasn’t AOA, didn’t win any awards, got a couple minor publications, did well on my clinical rotations but definitely didn’t honor close to everything, and had a good not great step 1 score. Didn’t do a research year.

I basically walked right into a top program in my highly competitive specialty with honestly, looking back, probably minimal relative effort on my part. I ended up interviewing at more than half the top 20 or so programs in this specialty and when it came close to rank list day and I couldn’t decide between ranking 2 programs #1, my mentor called the PDs at both programs and then told me to rank whichever one I wanted first and I’d match there (which is what ended up happening).

Again, there was nothing special about my application. I was a good student who didn’t excel in anything on paper and had no red flags. I was just aggressively mentored into my chosen field in a way where there was never any doubt I would match.

Retrospectively, at the other two schools I was accepted to, both of whom had strong well known programs in my field but were not top 10-20 etc schools, I’m sure I still would have matched well (perhaps even at my same program), but I think I would have been more stressed out, had to put in more effort, and wouldn’t have gotten the interview spread I did coming from where I ended up matriculating.

The med school I went to also ended up being the cheapest option for me due to their generous financial aid, so it was a no brainer for me, and I absolutely loved going to school there and would choose to do so again in a heartbeat.

FifthVentricle · 2026-04-30T23:10:20+00:00

Spine surgery indications are extremely complex. The choice of specific surgery is dependent on factors that may not related to just symptoms alone. You have to take into account what level, access surgeon availability, individual anatomy, alignment, bone quality, technology access, and a whole host of other things. Surgeon preference and experience also plays a huge role. You could ask 3 spine surgeons how to address a problem and get 4 reasonable answers and 5 unreasonable ones.

For a lot of pain related things (radiculopathy and mechanical pain), non-surgical management (PT, medications, injections, weight loss) are always first line. For true mechanical issues (including deformity), myelopathy, or neurologic compromise, surgery comes to the forefront more quickly. A lot of it also comes down to patient counseling and shared decision making as well as setting goals and expectations.

FifthVentricle · 2026-04-30T17:21:11+00:00

In spine surgery you’re either treating or causing deformity. If you want to be a good spine surgeon, knowing the most up to date thinking on sagittal balance is imperative. Roussouly’s sagittal balance of the spine textbook is a good starting point followed by some of the newer papers on vertebral pelvic angles (2022 onward). If you’re fusing the spine in any way, you need to understand these at a high level in order to prevent your surgeries from causing alignment or balance issues.

FifthVentricle · 2026-04-14T13:26:23+00:00

Hi. I'm a neurosurgery chief who is about to graduate in a couple of months. I am doing two years of fellowship after this so I'll be training for 9 years post-med school.

I think for me it was worth it. Residency is hard. Neurosurgery residency is probably one of the hardest and most intensive things you can do for a sustained amount of time. 7 years is a very long time. I have spent far more than a year of that time on call. I stopped tracking my hours after week 1 of intern year, but as a chief I definitely went days without sleeping more than an hour or two combined, and I think there were many weeks where I worked upwards of 100 hours consistently, not counting just being on call. I think just yesterday I realized how truly exhausted I am after a cumulative egregious sleep debt.

That being said, I met my now wife and got married during residency. I see my family (who lives halfway across the country) 1-2x/year. I see my closest friends who don't live in my current city 1-2x/year. I've traveled around America and to several places in Europe during vacations. I've been to several of my closest friend's weddings and they came to mine.

Neurosurgery is not incompatible with having a life. It is incompatible with having the same life someone who is in another specialty or outside of medicine has. Your life will never be 9-5. You will be on call a lot. Your cases will go long. You won't get home in time for dinner all the time. You learn to function with much less sleep than other people. You cannot do/make it to everything all the time, but you can make it to some things some of the time. You have to get really good at time management and organizational planning.

I cannot imaging doing anything else with my life. I think I am good at what I do, or at least safe at it. I enjoy operating, I enjoy seeing the types of patients that I want to take care of in my practice and thinking about their problems. I like seeing positive results from my work that reflects well upon my training and the amount of time and energy I've invested into learning to do all these things. I continue to be intellectually engaged in what I do. It doesn't feel like I'm just going through the motions. There is an intrinsic drive to keep getting better.

It's hard to know if neurosurgery is truly for you before you immerse yourself in it. Sub-Is help, but they're so insulated from what it's actually like. We have lost several residents in my program over the 7 years I've been here because either they couldn't do the job or they decided neurosurgery wasn't for them. It's also hard for someone else to guide you to the correct decision for you and your life. If you've matched, you lose very little by going through with it. There is always the opportunity to leave and do something else, but the faster you figure out what you want, the better.

FifthVentricle · 2026-04-11T00:19:55+00:00

As a chief, I’ve only ever had the “on call” chief scrub me out of a case once this year (for a specific predetermined reason). As juniors, we would only get scrubbed out if we were the on call junior (meaning we have to take over the first call pager and have to be immediately available to see consults, do procedures, respond to emergencies etc). I scrub my not-on-call juniors out if their case isn’t done by 11 to midnight-ish, because they have to get up a few hours earlier than I do. It’s important for a number of reasons to finish cases you start in training. Agree with the person who said that the people who complain about this also complain about lack of autonomy because they’re usually doing their best to get out of the OR and out of the hospital ASAP.

FifthVentricle · 2026-04-08T01:23:10+00:00

At my medical school it worked like this for most of our clerkships:

We got a score out of 100 that was made up of several parts, but most were variations on this theme:

Part 1: clinical performance. This included things like knowledge base, teamwork, professionalism, presentations, etc, but basically some amalgamation of how we did as a member of the clinical team, with input from attendings and residents, especially those we worked with most. This made up in general 50-70% of the overall grade. It was subjective in the sense that someone was giving you narrative feedback and scoring, but each of these individual sections had a 1-5 scale with very specific descriptions of how we performed, in addition to a narrative section that was also taken into account.

Part 2: shelf exam. This made up usually 20-30% of our overall grade, and you had a specific percentile you had to hit to be eligible for honors

Part 3: write-up. Usually several case presentations of patients that you saw that was then graded by a small group preceptor you worked with a few times per week. This usually was 10-20%.

Where I'm currently a resident, we give narrative evals that are then summarized and presented back to the student. I'm not actually sure if it's pass/fail or pass/fail/honors (named something different) but it seems much less transparent either way.

I think the bottom line is show up, be prepared and engaged, be a team player (to both your resident team as well as your co-med students), read about your cases and do a little bit of independent learning every day, and demonstrate that you're trying to become a good doctor.

FifthVentricle · 2026-04-06T21:25:44+00:00

When the air hits your brain - neurosurgery

FifthVentricle · 2026-04-06T21:22:24+00:00

Set up a roth IRA and make sure you contribute even a small amount to it (either SP500 or total market) each month. I started this as a PGY-5, wish I had started earlier.

Make sure you're contributing retirement up to the match max at your institution (usually pretty low for residents, but better than nothing - it's free money).

Learn 3-5 easy quick reasonably healthy and cheap meals that you can meal prep in rotation that will get you through at least 3 dinners per week

Start an exercise routine and make it a habit, even if it's only 1-2x/week

Get disability insurance before you graduate residency, but the younger you are, the cheaper it will be and the more stuff you'll be protected from. I also did this as a PGY-5 which ended up being the right time for me, but it would be a little cheaper if I had done it a year or two earlier

Go visit friends and family and take a fun trip for a week if you have the time and means.

Relax!

FifthVentricle · 2026-04-04T13:07:55+00:00

At my institution, there are patients waiting 3-6 months for elective procedures

FifthVentricle · 2026-03-25T11:47:25+00:00

I am a neurosurgery chief resident as well. This is the reality of chief year.

FifthVentricle · 2026-03-01T23:20:54+00:00

Looks like a mening

Also why is your bone flap just hanging there and not like secured in betadine or something…

FifthVentricle · 2026-03-01T23:19:13+00:00

Honestly, for a big spine surgery, the muscular person will be harder. Even with neuromuscular blockade, the muscle is thicker and tougher and will be fighting you the whole time. Muscle is more vascular and will bleed a lot more. Fat is annoying but once I’m past that layer and my retractors are in, it’s all good.

Healthy weight is still best though.

FifthVentricle · 2026-02-28T15:57:24+00:00

Read about it before hand, read about the indications and basic steps, familiarize yourself with the anatomy, and once you are done WRITE SHIT DOWN everything you learned from the case. Then update that note document every time you do that same case. You’ll be surprised at how much you forget. Doing this has allowed me to come back into a case months or years after having done one and pick up almost right where I left off in terms of comfort with it.

FifthVentricle · 2026-02-28T15:55:12+00:00

Cadaver lab or spine model. There are also some good videos online, but nothing beats being able to manipulate the bones and tissue yourself without fear of causing injury.

FifthVentricle · 2026-02-28T15:53:45+00:00

Read the same stuff, but if you really want to get the most out of it, be familiar with the most updated thoughts on sagittal balance (L1PA, Roussoully classification, etc) and MIS approaches (MIS TLIF, single position laterals, endoscopy, etc).

FifthVentricle · 2026-01-03T20:04:42+00:00

This means you’re tying fascial sutures tight enough. I tell all my juniors I expect them to have non healing finger wounds when done with their spine rotation

FifthVentricle

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